Anaesthetic modalities and post-operative outcomes in spinal cord injury urolithiasis: A systematic review
Bibliographic record
Abstract
Objectives: Spinal cord injury (SCI) patients are at an increased risk of urolithiasis and are associated with increased perioperative morbidity and mortality. The optimal anaesthetic agent in these patients remains contentious, reflecting a paucity of large-scale clinical trials. This systematic review aims to summarise the existing evidence comparing general anaesthesia (GA) with non-GA induction for surgical treatment of stones for these patients. Materials and methods: Ovid MEDLINE, Cochrane, and PubMed databases were searched up to 30 March 2024. Eligible studies assessed SCI patients receiving surgical procedures for stones with a specified anaesthetic induction method detailed. Our primary outcomes were stone-free rate (SFR) and all-cause mortality. Secondary outcomes included intraoperative and post-operative complications, intensive care admissions, and mean hospital stay. Results: Fifteen cohort, observational, and case–control studies were included. The available data demonstrated no meaningful trend between cohorts receiving GA and non-GA induction, across all outcomes. Studies exhibited significant heterogeneity in the direct comparison of GA with non-GA methods. Type of non-GA method, incidence of complications and outcome reporting were inconsistently reported, precluding reliable meta-analysis. Methodological quality was scored on the modified Newcastle Ottawa Scale which found eligible studies to be of poor to good quality. Conclusion: Evidence around outcomes in non-GA and GA-induced treatment is inconclusive and poor. We suggest larger scale, prospective studies to further stratify risk of poor outcomes between these two groups.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.008 |
| Bibliometrics | 0.006 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".