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Latest & greatest articles for surgery
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on surgery or other clinical topics then use Trip today.
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De-intensified adjuvant (chemo)radiotherapy versus standard adjuvant chemoradiotherapy post transoral minimally invasive surgery for resectable HPV-positive oropharyngeal carcinoma. BACKGROUND: More than 400,000 cases of oropharyngeal squamous cell cancer (OPSCC) are diagnosed every year worldwide and this is rising. Much of the increase has been attributed to human papillomavirus (HPV). HPV-positive OPSCC patients are often younger and have significantly improved survival relative to HPV (...) -negative patients. Traditional management of OPSCC has been with radiotherapy with or without chemotherapy, as this was shown to have similar survival to open surgery but with significantly lower morbidity. Techniques have evolved, however, with the development of computerised planning and intensity-modulated radiotherapy, and of minimally invasive surgical techniques. Acute and late toxicities associated with chemoradiotherapy are a significant burden for OPSCC patients and with an ever-younger cohort
Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. BACKGROUND: People undergoing multimodal cancer treatment are at an increased risk of adverse events. Physical fitness significantly reduces following cancer treatment, which is related to poor postoperative outcome. Exercise training can stimulate skeletal muscle adaptations, such as increased mitochondrial content and improved oxygen uptake capacity may contribute to improved physical fitness (...) . OBJECTIVES: To determine the effects of exercise interventions for people undergoing multimodal treatment for cancer, including surgery, on physical fitness, safety, health-related quality of life (HRQoL), fatigue, and postoperative outcomes. SEARCH METHODS: We searched electronic databases of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, SPORTDiscus, and trial registries up to October 2018. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared
Trends in Drug Use-Associated Infective Endocarditis and Heart Valve Surgery, 2007 to 2017: A Study of Statewide Discharge Data. Background: Drug use-associated infective endocarditis (DUA-IE) is increasing as a result of the opioid epidemic. Infective endocarditis may require valve surgery, but surgical treatment of DUA-IE has invoked controversy, and the extent of its use is unknown. Objective: To examine hospitalization trends for DUA-IE, the proportion of hospitalizations with surgery (...) , patient characteristics, length of stay, and charges. Design: 10-year analysis of a statewide hospital discharge database. Setting: North Carolina hospitals, 2007 to 2017. Patients: All patients aged 18 years or older hospitalized for IE. Measurements: Annual trends in all IE admissions and in IE hospitalizations with valve surgery, stratified by patients' drug use status. Characteristics of DUA-IE surgical hospitalizations, including patient demographic characteristics, length of stay, disposition
Pre-emptive and preventive opioids for postoperative pain in adults undergoing all types of surgery. BACKGROUND: Postoperative pain is a common consequence of surgery and can have deleterious effects. It has been suggested that the administration of opioid analgesia before a painful stimulus may improve pain control. This can be done in two ways. We defined 'preventive opioids' as opioids administered before incision and continued postoperatively, and 'pre-emptive opioids' as opioids given (...) before incision but not continued postoperatively. Both pre-emptive and preventive analgesia involve the initiation of an analgesic agent prior to surgical incision with the aim of reducing intraoperative nociception and therefore postoperative pain. OBJECTIVES: To assess the efficacy of preventive and pre-emptive opioids for reducing postoperative pain in adults undergoing all types of surgery. SEARCH METHODS: We searched the following electronic databases: CENTRAL, MEDLINE, Embase, AMED, and CINAHL
Laparoscopic versus open surgery for suspected appendicitis. BACKGROUND: The removal of the acute appendix is one of the most frequently performed surgical procedures. Open surgery associated with therapeutic efficacy has been the treatment of choice for acute appendicitis. However, in consequence of the evolution of endoscopic surgery, the operation can also be performed with minimally invasive surgery. Due to smaller incisions, the laparoscopic approach may be associated with reduced (...) no pooled estimates were presented. One used the SF-36 questionnaire two weeks after surgery and the other used the Gastro-intestinal Quality of Life Index six weeks and six months after surgery (both low-quality evidence).In children, we found no differences in pain intensity on day one (MD -0.80, 95% CI -1.65 to 0.05; 1 RCT; 61 participants; low-quality evidence), intra-abdominal abscesses after LA (Peto OR 0.54, 95% CI 0.24 to 1.22; 9 RCTs; 1185 participants; low-quality evidence) or time until
Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery. BACKGROUND: Endoscopic sinus surgery (ESS) is often recommended for symptomatic patients with recurrent acute or chronic rhinosinusitis who have failed conservative treatment. Postoperative care has been felt to be critical for both maintaining the surgical patency of the operated sinuses and improving patient symptoms. Debridement of the sinonasal cavities is one (...) such postoperative care measure that has frequently been studied in the literature, often with conflicting conclusions. OBJECTIVES: To assess the effects of postoperative sinonasal debridement versus no debridement following endoscopic sinus surgery. SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL, via the Cochrane Register of Studies); PubMed; EMBASE; Web of Science; ClinicalTrials.gov; ICTRP and additional sources
Subpial transection surgery for epilepsy. BACKGROUND: Nearly 30% of patients with epilepsy continue to have seizures despite using several antiepileptic drugs (AEDs). Such patients are regarded as having refractory, or uncontrolled, epilepsy. While there is no universally accepted definition of uncontrolled, or medically refractory, epilepsy, for the purposes of this review we will consider seizures as drug resistant if they have failed to respond to a minimum of two AEDs. Specialists consider (...) that early surgical intervention may prevent seizures at a younger age, which in turn may improve the intellectual and social status of children. Many types of surgery are available for treating refractory epilepsy; one such procedure is known as subpial transection. OBJECTIVES: To assess the effects of subpial transection for focal-onset seizures and generalised tonic-clonic seizures in children and adults. SEARCH METHODS: For the latest update we searched the following databases on 7 August 2018
A Simple Screening Tool to Predict Outcomes in Older Adults Undergoing Emergency General Surgery 30298686 2018 10 09 1532-5415 2018 Oct 09 Journal of the American Geriatrics Society J Am Geriatr Soc A Simple Screening Tool to Predict Outcomes in Older Adults Undergoing Emergency General Surgery. 10.1111/jgs.15627 To determine whether the Flemish version of the Triage Risk Screening Tool (fTRST) can be used to accurately assess frailty in an emergency setting. Prospective observational study (...) . of a tertiary referral hospital. All individuals aged 70 and older consecutively admitted to the emergency surgery unit with an urgent need for abdominal surgery between December 2015 and May 2016 who met inclusion criteria (N=110). Individuals were screened with the fTRST and additional metrics such as the age-adjusted Charlson Comorbidity Index and American Society of Anesthesiology score. Thirty- and 90-day postoperative complications where recorded. Regression analyses were performed to identify
Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities 30288096 2018 11 14 1178-7090 11 2018 Journal of pain research J Pain Res Efficacy of preemptive analgesia on acute postoperative pain in children undergoing major orthopedic surgery of the lower extremities. 2061-2070 10.2147/JPR.S175169 Children undergoing major orthopedic surgery of the lower extremities can experience severe postoperative pain; yet, the ideal (...) postoperative pain management strategy is unknown. Thus, in this patient population, we investigated the effect of intraoperative epidural infusion of local anesthetic on acute postoperative pain and analgesic consumption. Patients (N=50, 3-12 years) randomly received either ropivacaine 0.15% (preemptive group) or normal saline (control group) as an initial bolus of 0.2 mL/kg, followed by continuous infusion of 0.15 mL/kg/h throughout surgery. Following surgery, patient-controlled epidural analgesia with
Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis 30267040 2018 09 29 2168-6262 2018 Sep 26 JAMA surgery JAMA Surg Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. e183467 10.1001/jamasurg.2018.3467 Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden (...) . The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search
Hypnosis intervention for the management of pain perception during cataract surgery 30288086 2018 11 14 1178-7090 11 2018 Journal of pain research J Pain Res Hypnosis intervention for the management of pain perception during cataract surgery. 1921-1926 10.2147/JPR.S174490 To investigate the effectiveness of hypnosis in pain management during cataract surgery. Male or female patients with bilateral age-related cataract who wished to have both eyes subjected to phacoemulsification surgery were (...) preliminarily admitted. Immediately after the first-eye surgery, each patient was evaluated for pain using the visual analog scale (VAS), and patients with a VAS score >1 were enrolled. By using block randomization, the enrolled patients were allocated to either the treatment group, which received a hypnosis intervention before the scheduled second-eye surgery, or the control group, which did not undergo hypnosis. The levels of anxiety, pain, and cooperation were evaluated independently by the patients
Network meta-analysis of topical haemostatic agents in thyroid surgery 30199093 2018 10 12 1365-2168 105 12 2018 Nov The British journal of surgery Br J Surg Network meta-analysis of topical haemostatic agents in thyroid surgery. 1573-1582 10.1002/bjs.10975 The objective of this study was to investigate the potential benefit of local haemostatic agents for the prevention of postoperative bleeding after thyroidectomy. A systematic literature search was performed, and RCTs involving adult (...) patients who underwent thyroid surgery using either active (AHA) or passive (PHA) haemostatic agents were included in the review. The main outcome was the rate of cervical haematoma that required reoperation. A Bayesian random-effects model was used for network meta-analysis with minimally informative prior distributions. Thirteen RCTs were included. The rate of cervical haematoma requiring reoperation ranged from 0 to 9·1 per cent, and was not reduced by haemostatic agents: AHA versus control (odds
Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT-Trial) 30247329 2018 09 24 1528-1140 2018 Sep 20 Annals of surgery Ann. Surg. Long-term Outcome of Surgery Versus Conservative Management for Recurrent and Ongoing Complaints After an Episode of Diverticulitis: 5-year Follow-up Results of a Multicenter Randomized Controlled Trial (DIRECT (...) score (P = 0.016), and a lower VAS pain score (P = 0.011). Twenty-six (46%) patients in the conservative group ultimately required surgery due to severe ongoing complaints. Of the operatively treated patients, 8 (11%) patients had anastomotic leakage and reinterventions were required in 11 (15%) patients. Consistent with the short-term results of the DIRECT trial, elective sigmoidectomy resulted in a significantly increased QoL at 5-year follow-up compared with conservative management in patients
Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome 30282398 2018 10 04 2150-1149 21 5 2018 Sep Pain physician Pain Physician Comparison of 3 Approaches to Percutaneous Epidural Adhesiolysis and Neuroplasty in Post Lumbar Surgery Syndrome. E501-E508 Percutaneous epidural adhesiolysis and neuroplasty (PEAN) has been proven to be safe and effective in treating different spine pathologies, in particular post lumbar surgery syndrome (PLSS (...) study was limited by the low number of patients and the short duration (6 months) of follow-up. The 3 anatomical approaches (caudal, S1 foraminal, and L5-S1 transforaminal) result in the same outcome with regard to pain relief and complication rate. Post lumber surgery syndrome, post laminectomy back pain, percutaneous adhesiolysis, Racz catheter, percutaneous neuroplasty. Akbas Mert M Algology Division, Department of Anesthesia, Akdeniz University, Antalya, Turkey. Elawamy Abdel Reheem AR
Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis 30307031 2018 10 11 1532-5415 2018 Oct 11 Journal of the American Geriatrics Society J Am Geriatr Soc Cognitive Outcomes After Heart Valve Surgery: A Systematic Review and Meta-Analysis. 10.1111/jgs.15601 To summarize evidence on cognitive outcomes after heart valve surgery; secondary aim, to examine whether aortic and mitral valve surgery are associated with different cognitive outcomes. Preferred Reporting (...) Items for Systematic Reviews and Meta-Analyses systematic review and meta-analysis. Cardiac surgery. Individuals undergoing heart valve surgery. We searched MEDLINE, EMBASE, and PsycINFO for peer-reviewed reports of individuals undergoing heart valve surgery who underwent pre- and postoperative cognitive assessment. Our initial search returned 1,475 articles, of which 12 were included. Postoperative cognitive results were divided into those from 1 week to 1 month (early outcomes, n pooled = 450
Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery 30336826 2018 10 19 1558-3597 72 17 2018 Oct 23 Journal of the American College of Cardiology J. Am. Coll. Cardiol. Risk of Thromboembolism Associated With Atrial Fibrillation Following Noncardiac Surgery. 2027-2036 S0735-1097(18)37078-5 10.1016/j.jacc.2018.07.088 The long-term risk of thromboembolism in patients developing new-onset post-operative atrial fibrillation (POAF) following noncardiac surgery (...) is unknown, and data on stroke prophylaxis in this setting are lacking. The purpose of this study was to assess the long-term risk of thromboembolism in patients developing new-onset POAF following noncardiac surgery relative to patients with nonsurgical, nonvalvular atrial fibrillation (NVAF). Using Danish nationwide registries, the authors identified all patients who developed POAF following noncardiac surgery from 1996 to 2015. These were matched by age, sex, heart failure, hypertension, diabetes
Does Mechanical Bowel Preparation Reduce the Risk of Developing Infectious Complications in Pediatric Colorectal Surgery? A Systematic Review and Meta-Analysis 30219553 2018 09 16 1097-6833 2018 Sep 12 The Journal of pediatrics J. Pediatr. Does Mechanical Bowel Preparation Reduce the Risk of Developing Infectious Complications in Pediatric Colorectal Surgery? A Systematic Review and Meta-Analysis. S0022-3476(18)30962-4 10.1016/j.jpeds.2018.07.057 To evaluate whether the application (...) of mechanical bowel preparation (MBP) before colorectal surgery reduces the risk of developing infectious complications in children. In this systematic review and meta-analysis, PubMed, Embase, and the Cochrane Library were systematically searched to identify all articles comparing pediatric patients receiving MBP with pediatric patients not receiving MBP before colorectal surgery. Results are presented with weighted risk differences based on the number of events and sample size per study. Six original
Low-dose sedative reduces sudden confusion after major surgery in older adults Signal - Low-dose sedative reduces sudden confusion after major surgery in older adults Dissemination Centre Discover Portal NIHR DC Discover Low-dose sedative reduces sudden confusion after major surgery in older adults Published on 21 December 2016 Giving a low-dose sedative to older adults in intensive care after surgery reduces sudden confusion, also known as delirium, without increasing the risk of adverse (...) effects. In this Chinese trial, adults aged 65 or over were given an intravenous drip of the sedative dexmedetomidine on their first day in intensive care following non-heart surgery. Nine percent experienced delirium up to seven days later compared to 23% who received salt-solution placebo. They were less likely to have high blood pressure or fast heart rate, without any increase in the number with low blood pressure or heart rate. Delirium is common after major surgery and in the intensive
General surgery is mostly safe during pregnancy Signal - General surgery is mostly safe during pregnancy Dissemination Centre Discover Portal NIHR DC Discover General surgery is mostly safe during pregnancy Published on 10 January 2017 Routine data from English hospitals show that general surgery during pregnancy, such as removing the appendix or gallbladder, does not commonly harm mother or baby. This suggests that surgery in pregnant women is generally safe, but that mothers could be provided (...) with more specific estimates of the risks. This large observational study assessed the “real world” outcomes of nearly 6.5 million pregnancies at hospitals in England over a 10-year period. Women who had surgery during pregnancy for a condition unrelated to pregnancy were slightly more likely to experience miscarriage, preterm or caesarean delivery or a long stay in hospital. Babies were more also slightly more likely to be low birthweight or stillborn. However, the actual risks of negative outcomes