Latest & greatest articles for surgery

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Top results for surgery

41. Low-dose sedative reduces sudden confusion after major surgery in older adults

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

NIHR Dissemination Centre2018

42. General surgery is mostly safe during pregnancy

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

NIHR Dissemination Centre2018

43. Eye surgery to remove the lens shows promise for treating early glaucoma

Eye surgery to remove the lens shows promise for treating early glaucoma Signal - Eye surgery to remove the lens shows promise for treating early glaucoma Dissemination Centre Discover Portal NIHR DC Discover Eye surgery to remove the lens shows promise for treating early glaucoma Published on 24 January 2017 Lens extraction, a procedure usually used to remove cataracts, could be a better first choice for some people with one type of glaucoma than laser treatment. Glaucoma is a group of eye (...) , China and East Asia. Researchers recruited adults over 50 who were newly diagnosed with primary angle-closure glaucoma or its precursor primary angle closure. None of them had cataracts or previous eye surgery. Researchers randomly allocated 208 people to clear-lens extraction surgery and 211 to standard care of laser peripheral iridotomy, followed by eye drops. They measured the results after 36 months, comparing eye pressure, overall health status and cost effectiveness. The results of this large

NIHR Dissemination Centre2018

44. Following programmes to improve recovery after surgery linked to shorter hospital stays

Following programmes to improve recovery after surgery linked to shorter hospital stays Signal - Following programmes to improve recovery after surgery linked to shorter hospital stays Dissemination Centre Discover Portal NIHR DC Discover Following programmes to improve recovery after surgery linked to shorter hospital stays Published on 24 January 2017 Reduced compliance with enhanced recovery protocols was associated with more days in hospital after keyhole bowel surgery, an increased (...) likelihood of readmission and complications. Enhanced recovery, also known as fast track access, is considered standard practice but there is considerable variation in what this means and how this is implemented locally. This systematic review included 34 studies where protocols were used to enhance recovery after laparoscopic colorectal resection surgery. The review aimed to identify which elements of local protocols such as early walking or epidural anaesthesia, are associated with a successful outcome

NIHR Dissemination Centre2018

45. Delaying chemotherapy after breast cancer surgery may reduce survival chances

Delaying chemotherapy after breast cancer surgery may reduce survival chances Signal - Delaying chemotherapy after breast cancer surgery may reduce survival chances Dissemination Centre Discover Portal NIHR DC Discover Delaying chemotherapy after breast cancer surgery may reduce survival chances Published on 31 January 2017 Delaying chemotherapy after breast cancer surgery may slightly decrease a woman’s chances of survival. A review found about a 5% increase in the relative risk of death. Many (...) women are offered chemotherapy soon after breast cancer surgery, called adjuvant chemotherapy. Chemotherapy is usually started after the surgical wounds have healed but the effect of any delay to this was unclear. These researchers calculated the risk from outcomes for almost 30,000 women treated with adjuvant chemotherapy, from studies in Europe and North America. The absolute risk of death for any woman will depend on her individual cancer stage and characteristics. A four week delay could add

NIHR Dissemination Centre2018

46. Ultrasound therapy doesn’t speed healing of leg fracture after surgery

Ultrasound therapy doesn’t speed healing of leg fracture after surgery Signal - Ultrasound therapy doesn’t speed healing of leg fracture after surgery Dissemination Centre Discover Portal NIHR DC Discover Ultrasound therapy doesn’t speed healing of leg fracture after surgery Published on 7 February 2017 Low intensity pulsed ultrasound (LIPUS), sometimes used to encourage bone fractures to heal after surgery, makes no difference to how soon people can get back to their normal activities (...) or to the speed at which bones appear to heal on x-ray. The biggest trial of the treatment to date recruited 501 adults with a fractured tibia (shin bone) and who’d had the break fixed surgically. They were asked to use LIPUS for a year at home, or until the bone had healed. Half were given dummy equipment which looked and sounded identical. Dropping LIPUS as a treatment after fixation surgery for tibial fractures could save NHS resources for use on other things. Share your views on the research. Why

NIHR Dissemination Centre2018

47. Men feel physically and psychologically ill-prepared for prostate cancer surgery

Men feel physically and psychologically ill-prepared for prostate cancer surgery Signal - Men feel physically and psychologically ill-prepared for prostate cancer surgery Dissemination Centre Discover Portal NIHR DC Discover Men feel physically and psychologically ill-prepared for prostate cancer surgery Published on 28 November 2017 Following prostate cancer surgery men often experience physical changes, such as urinary incontinence and erectile dysfunction, causing negative emotions (...) and distress. This review found that men felt poorly prepared – psychologically and physically – for the changes they might experience after surgery. Surgery was often described as "life-changing", and men described worrying about their future. NICE recommend that men and their partners/carers are fully informed about prostate cancer treatment options and their possible complications, and are supported in decision-making. This includes having access to psychosexual support at any time. This global review

NIHR Dissemination Centre2018

48. Alternative drug may prevent atrial fibrillation following heart surgery

Alternative drug may prevent atrial fibrillation following heart surgery Signal - Alternative drug may prevent atrial fibrillation following heart surgery Dissemination Centre Discover Portal NIHR DC Discover Alternative drug may prevent atrial fibrillation following heart surgery Published on 12 December 2017 After heart surgery around a third of people have atrial fibrillation, an abnormal heart rhythm, which impedes their recovery and lengthens hospital stay. Colchicine treatment could (...) and could be safer. Further study needs to clarify which patient groups could benefit from colchicine, how it compares against current treatments and which dose strikes the best balance between efficacy and side effects. Share your views on the research. Why was this study needed? Atrial fibrillation is common following heart surgery, affecting approximately 25-40% of people having coronary artery bypass surgery, and 50-60% of people requiring valve surgery. Untreated, it increases the risk

NIHR Dissemination Centre2018

49. Using mesh does not improve results in vaginal prolapse surgery

Using mesh does not improve results in vaginal prolapse surgery Signal - Using mesh does not improve results in vaginal prolapse surgery Dissemination Centre Discover Portal NIHR DC Discover Using mesh does not improve results in vaginal prolapse surgery Published on 15 August 2017 Using a synthetic mesh or biological tissue graft is no better than standard surgical repair, without the use of these materials, in women with vaginal wall prolapse. Some women had problems from the mesh. This large (...) pragmatic study looked at over 3000 women with vaginal prolapse. Half of these were randomised; the rest contributed data but were not part of the main evaluation. The study separately compared mesh and biological grafts to a repair without these additions. It also took account of whether it was women’s first or subsequent repair operation. There was no difference in prolapse symptoms or quality of life at two years in women who had surgery that used mesh or biological graft and those who had standard

NIHR Dissemination Centre2018

50. Wound complications remain a concern for CABG surgery using both mammary arteries

Wound complications remain a concern for CABG surgery using both mammary arteries Signal - Wound complications remain a concern for CABG surgery using both mammary arteries Dissemination Centre Discover Portal NIHR DC Discover Wound complications remain a concern for CABG surgery using both mammary arteries Published on 7 February 2017 Rates of death, heart attack and stroke were similar at five years for people who underwent coronary artery bypass graft (CABG) using one or both mammary (...) arteries. Bypass surgery involves grafting another blood vessel to bypass the narrowed or blocked artery to improve blood flow to the heart muscle. The left mammary (internal thoracic) artery is often used. Previous research had shown outcomes may be improved by using both left and right mammary arteries but bilateral procedures are more complicated. This trial found no difference in early mortality or vascular outcomes although wound complications and sternum (breastbone) reconstructions were more

NIHR Dissemination Centre2018

51. Suction drainage after rectal cancer surgery does not reduce infection

Suction drainage after rectal cancer surgery does not reduce infection Signal - Suction drainage after rectal cancer surgery does not reduce infection Dissemination Centre Discover Portal NIHR DC Discover Suction drainage after rectal cancer surgery does not reduce infection Published on 28 February 2017 Placing a suction drain in the pelvic cavity does not reduce the risk of pelvic infection after commonly-used surgery for rectal cancer. A French trial comparing results of surgery (...) with and without pelvic drainage showed no difference in risk of infection within 30 days. The risk of infection was about 17%. The drainage technique is less commonly used in the UK. The study was carried out in several hospitals and included 469 people having total mesorectal excision of rectal cancer. Half the patients were randomised to suction drainage. Surgical techniques included laparoscopic and open surgery, with staples or stitches. Patients were followed up for signs of pelvic infection, leakage

NIHR Dissemination Centre2018

52. Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival

Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Signal - Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Dissemination Centre Discover Portal NIHR DC Discover Intensive follow-up following curative bowel cancer surgery may detect recurrent cancers sooner but does not improve survival Published on 28 February 2017 Intensive follow-up (...) of patients who have been successfully treated for bowel cancer does not improve survival outcomes compared to less intensive follow-up. This systematic review included 15 randomised controlled trials comparing different intensities of follow-up. Protocols varied in terms of the number of tests, appointments or their setting (e.g. GP or hospital) - none of them affected survival. More intensive follow-up did however detect recurrent cancers sooner, and patients were twice as likely to undergo surgery

NIHR Dissemination Centre2018

53. Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer

Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Signal - Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Dissemination Centre Discover Portal NIHR DC Discover Postoperative radiotherapy reduces survival after surgery to remove non-small cell lung cancer Published on 28 February 2017 Postoperative radiotherapy increases the risk of death by 18% for patients with non-small cell lung cancer that has been (...) removed by surgery. Just over half of patients (53%) given radiotherapy after surgery survived to two years following treatment. This compared to 58% of patients who did not receive postoperative radiotherapy. Previous evidence had suggested that postoperative radiotherapy may be beneficial after curative surgery. This Cochrane review contradicts this, drawing on data from 2,343 people across 11 good quality trials. It demonstrates that postoperative radiotherapy may have a detrimental effect

NIHR Dissemination Centre2018

54. Laminar airflow in surgery might not reduce surgical site infections

Laminar airflow in surgery might not reduce surgical site infections Signal - Laminar airflow in surgery might not reduce surgical site infections Dissemination Centre Discover Portal NIHR DC Discover Laminar airflow in surgery might not reduce surgical site infections Published on 11 July 2017 The type of theatre ventilation system used during hip and knee replacement, abdominal or vascular surgery has no effect on the rate of surgical site infections. Prevention of surgical site infection (...) is a complex area with many potential targets for action. So decisions relating to commissioning or decommissioning these systems will need to consider the totality of the evidence alongside the costs. This systematic review included 12 observational studies comparing wound infection rates following surgery performed in theatres using laminar airflow or conventional ventilation. Laminar ventilation distributes air in parallel layers, forming a “curtain” which has been thought to limit contamination

NIHR Dissemination Centre2018

55. Antibiotics by injection into the eye can prevent severe infection following cataract surgery

Antibiotics by injection into the eye can prevent severe infection following cataract surgery Signal - Antibiotics by injection into the eye can prevent severe infection following cataract surgery Dissemination Centre Discover Portal NIHR DC Discover Antibiotics by injection into the eye can prevent severe infection following cataract surgery Published on 11 April 2017 Injecting the antibiotics vancomycin or moxifloxacin into the eyeball after eye surgery can reduce the risk of developing (...) severe infection inside the eye (endophthalmitis) compared to other routes. Cefuroxime is currently the antibiotic of choice for this in the UK, but researchers wanted to see if drugs with lower rates of resistance might also be effective. A of 34 studies, mostly observational studies with nine randomised controlled trials (RCTs), explored the effects of different types of antibiotic regimens on the risk of endophthalmitis in people who had received eye surgery. There were no randomised trials

NIHR Dissemination Centre2018

56. Dexamethasone before bowel surgery reduces postoperative nausea and vomiting

Dexamethasone before bowel surgery reduces postoperative nausea and vomiting Signal - Dexamethasone before bowel surgery reduces postoperative nausea and vomiting Dissemination Centre Discover Portal NIHR DC Discover Dexamethasone before bowel surgery reduces postoperative nausea and vomiting Published on 8 August 2017 A single dose of dexamethasone given at the time of anaesthesia for bowel surgery reduced vomiting in the next 24 hours, with no increase in complications. Thirteen people need (...) to be treated to prevent one extra episode of vomiting. Dexamethasone (a steroid) is one of several drugs recommended for patients at moderate and high risk of postoperative nausea and vomiting. It isn’t widely used in bowel surgery. In this large UK-based trial, treating eight people also prevented one person requesting additional anti-sickness drugs. There was no increase in adverse events, and patients given dexamethasone returned to eating quicker. Postoperative nausea and vomiting can delay recovery

NIHR Dissemination Centre2018

57. Aortic valve implantation without open surgery has short term benefits

Aortic valve implantation without open surgery has short term benefits Signal - Aortic valve implantation without open surgery has short term benefits Dissemination Centre Discover Portal NIHR DC Discover Aortic valve implantation without open surgery has short term benefits Published on 22 November 2016 For people with severe symptomatic aortic stenosis, implanting an aortic valve by guiding it into place through the blood vessels rather than by open heart surgery improves survival at two (...) years. This review pooled data from four major trials of different catheter-based devices in people who were eligible for either treatment. It found the less invasive approach improved survival compared to open heart surgery at two years, when the results for all surgical risk categories were combined. The less invasive approach is already an option for people who are at high surgical risk or cannot have open heart surgery because of the risk. The less invasive technique caused fewer initial

NIHR Dissemination Centre2018

58. Lack of evidence on whether collagenase or surgery is more clinically or cost effective in managing Dupuytren’s contracture

Lack of evidence on whether collagenase or surgery is more clinically or cost effective in managing Dupuytren’s contracture Signal - Lack of evidence on whether collagenase or surgery is more clinically or cost effective in managing Dupuytren’s contracture Dissemination Centre Discover Portal NIHR DC Discover Lack of evidence on whether collagenase or surgery is more clinically or cost effective in managing Dupuytren’s contracture Published on 22 December 2015 This review aimed to compare (...) injections of collagenase clostridium histolyticum with standard surgical treatments for Dupuytren’s contracture. Unfortunately existing trials are small and there are no head to head trials of surgery vs collagenase, so it is not possible to determine which therapy is more effective in the short or longer term - nor which is likely to be the more cost-effective. However, collagenase was clinically successful in 63% of cases, compared to just 6% for placebo. Draft guidance from NICE recommends against

NIHR Dissemination Centre2018

59. Breathing training before major surgery may reduce lung complications afterwards

Breathing training before major surgery may reduce lung complications afterwards Signal - Breathing training before major surgery may reduce lung complications afterwards Dissemination Centre Discover Portal NIHR DC Discover Breathing training before major surgery may reduce lung complications afterwards Published on 15 January 2016 This review found that physiotherapist-led training in breathing before heart or major abdominal surgery was associated with a reduced risk of lung collapse (...) or pneumonia after surgery. There was no evidence that it reduced the numbers of people ventilated for 48 hours or more, or the chance of death after the operation. Post-operative lung complications – such as collapse and pneumonia – are expensive and difficult to manage, with the risk of illness and death. Inspiratory muscle training (IMT) is a type of rehabilitation exercise that can be performed before surgery to try and help strengthen the muscles around the lungs and reduce the risk of PPCs. However

NIHR Dissemination Centre2018

60. A review of restricting blood supply to a limb before heart surgery highlights the need for better evidence

A review of restricting blood supply to a limb before heart surgery highlights the need for better evidence Signal - A review of restricting blood supply to a limb before heart surgery highlights the need for better evidence Dissemination Centre Discover Portal NIHR DC Discover A review of restricting blood supply to a limb before heart surgery highlights the need for better evidence Published on 18 January 2016 This review of trials looked at a procedure that restricts blood supply to a limb (...) just before heart surgery, which might prepare the heart for reduced blood flow during surgery. The technique was tested alongside the use of inhaled or injected anaesthetic. The review of 55 trials found the technique in combination with inhaled anaesthetic gave the best chance of survival compared to using an injected anaesthetic, not restricting blood supply before surgery or both. The underlying trials were small and few made the direct comparison required and so the authors called for more

NIHR Dissemination Centre2018