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.

This page lists the very latest high quality evidence on surgery and also the most popular articles. Popularity measured by the number of times the articles have been clicked on by fellow users in the last twelve months.

What is Trip?

Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

Trip has been online since 1997 and in that time has developed into the internet’s premier source of evidence-based content. Our motto is ‘Find evidence fast’ and this is something we aim to deliver for every single search.

As well as research evidence we also allow clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news.

For further information on Trip click on any of the questions/sections on the left-hand side of this page. But if you still have questions please contact us via jon.brassey@tripdatabase.com

Top results for surgery

61. Early oral feeding after stomach surgery is safe and reduces time spent in hospital

Early oral feeding after stomach surgery is safe and reduces time spent in hospital Signal - Early oral feeding after stomach surgery is safe and reduces time spent in hospital Dissemination Centre Discover Portal NIHR DC Discover Early oral feeding after stomach surgery is safe and reduces time spent in hospital Published on 24 March 2016 After upper gastrointestinal surgery, returning a patient to oral feeding on the day of the surgery, or the day after, is as safe as waiting for a few days (...) . It also reduces the time the patient spends in hospital by about two days, potentially saving money. This systematic review and meta-analysis found no difference in adverse outcomes – such as leakage at the surgical site, need for re-insertion of a feeding tube, reoperations, readmissions or mortality – when adults were fed early compared with later after upper gastrointestinal surgery. Future research is needed on patient satisfaction and to see if patients undergoing surgery at different sites

NIHR Dissemination Centre2018

62. No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms

No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Signal - No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Dissemination Centre Discover Portal NIHR DC Discover No clear difference between open and keyhole surgery for the repair of ruptured abdominal aortic aneurysms Published on 3 May 2016 Open and keyhole surgery for repairing a ruptured abdominal aortic aneurysm show similar (...) rates of death at three months, though keyhole surgery leads to slightly shorter hospital stays. Women were found to benefit slightly more from the keyhole technique than men, according to this review and meta-analysis. An abdominal aortic aneurysm is a swelling of the aorta – the body’s main artery. Large aneurysms are rare but if they burst there is catastrophic bleeding. The traditional treatment for abdominal aortic aneurysm is open repair: keyhole repair (also known as endovascular repair

NIHR Dissemination Centre2018

63. Antibiotics are not necessary for preventing infections following simple hand surgery

Antibiotics are not necessary for preventing infections following simple hand surgery Signal - Antibiotics are not necessary for preventing infections following simple hand surgery Dissemination Centre Discover Portal NIHR DC Discover Antibiotics are not necessary for preventing infections following simple hand surgery Published on 24 May 2016 Antibiotics did not significantly reduce the number of infections in people with clean wounds who had simple hand surgery, this review found. NICE (...) guidance, published in 2008, recommends that antibiotics are not prescribed for uncomplicated surgery where the wound is clean. The findings of this review support this recommendation. This work also fits with NICE 2015 guidance on antimicrobial stewardship, providing information to improve antibiotic prescribing decisions. Many of the studies included in this review may have suffered from bias, so the results should be viewed with some caution. Share your views on the research. Why was this study

NIHR Dissemination Centre2018

64. Exercise testing shows potential as a way to identify high-risk patients for abdominal surgery

Exercise testing shows potential as a way to identify high-risk patients for abdominal surgery Signal - Exercise testing shows potential as a way to identify high-risk patients for abdominal surgery Dissemination Centre Discover Portal NIHR DC Discover Exercise testing shows potential as a way to identify high-risk patients for abdominal surgery Published on 24 May 2016 Cardiopulmonary exercise tests could be used as a risk-stratification tool in the preoperative assessment of patients due (...) to undergo some types of major abdominal surgery. This systematic review found that measuring anaerobic threshold during exercise testing was the most helpful predictor of risk for liver, pancreatic and general abdominal surgery, while peak oxygen uptake was best for abdominal aortic aneurysm repair. Identifying patients at risk of poor outcomes could help hospitals plan resources more effectively, for example by booking time in critical care for immediate postoperative care, and may improve

NIHR Dissemination Centre2018

65. Surgery to remove the thymus gland improves weakness for people with myasthenia gravis

Surgery to remove the thymus gland improves weakness for people with myasthenia gravis Signal - Surgery to remove the thymus gland improves weakness for people with myasthenia gravis Dissemination Centre Discover Portal NIHR DC Discover Surgery to remove the thymus gland improves weakness for people with myasthenia gravis Published on 3 October 2016 Having a thymectomy (surgery to remove the thymus gland) improves various measures of weakness and reduces the need for other treatment in people (...) with myasthenia gravis. When combined with standard steroid treatment, surgery gives a meaningful, but small, improvement compared with steroids alone. Importantly it also reduced the requirement for steroids or immune suppressing drugs and their side effects. Myasthenia gravis is a rare condition where the body’s own immune system attacks the nerves carrying signals to the muscles. This causes the muscles to become tired and weak. The thymus gland in the chest is part of the immune system. Although

NIHR Dissemination Centre2018

66. Uncertainty over the use of stents after telescopic surgery for kidney stones

Uncertainty over the use of stents after telescopic surgery for kidney stones Signal - Uncertainty over the use of stents after telescopic surgery for kidney stones Dissemination Centre Discover Portal NIHR DC Discover Uncertainty over the use of stents after telescopic surgery for kidney stones Published on 8 November 2016 Inserting a stent, a narrow tube, after ureteroscopic surgery for removal of kidney stones reduces unplanned hospital readmissions but causes more pain upon urination (...) . This review compared outcomes for patients having ureteroscopic surgery for stones who had a stent placed in the ureter (the tube connecting the kidney with the bladder) with patients who had the stent left out. There was significant variability in the results of the individual studies, and it is possible that clinical judgment was influencing the decision of whether or not to place a stent. The review shows there is a balance between the pros and cons of using a stent, and therefore a need for clinical

NIHR Dissemination Centre2018

67. One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements

One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements Signal - One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements Dissemination Centre Discover Portal NIHR DC Discover One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements Published on 30 August 2016 A one-stage knee replacement procedure to treat an infected prosthetic knee may offer similar outcomes for most people (...) as the more commonly used two-stage procedure. Re-infection was seen in 7.6% of people after one-stage revision surgery, compared to 8.8% after a two-stage procedure. Other outcomes, such as range of motion, were also similar. This review of observational studies described different techniques and approaches and because of the way this information was gathered there are some uncertainties as to whether these are now used or if other factors were important too. An infection is one of the most serious

NIHR Dissemination Centre2018

68. Epidural anaesthesia helps return of bowel function after abdominal surgery

Epidural anaesthesia helps return of bowel function after abdominal surgery Signal - Epidural anaesthesia helps return of bowel function after abdominal surgery Dissemination Centre Discover Portal NIHR DC Discover Epidural anaesthesia helps return of bowel function after abdominal surgery Published on 27 September 2016 High quality evidence suggests that an epidural anaesthetic (with or without an opioid) promotes the return of gut function after abdominal surgery. This is when compared (...) to an opioid based regimen, given either through an epidural or into the bloodstream. Epidural anaesthetic also gave a clinically meaningful reduction in pain. Evidence for other outcomes, including reduction in vomiting, was less reliable. Poor gut function and pain in the period following abdominal surgery are common. Opioid pain-relief also carries additional risks. Improving these factors could theoretically have benefits in terms of reducing hospital stays and costs. Ultimately, decisions to use

NIHR Dissemination Centre2018

69. Weight loss surgery is value for money in selected people with severe obesity

Weight loss surgery is value for money in selected people with severe obesity Signal - Weight loss surgery is value for money in selected people with severe obesity Dissemination Centre Discover Portal NIHR DC Discover Weight loss surgery is value for money in selected people with severe obesity Published on 23 August 2016 Surgery is a cost-effective method of weight loss for severely and morbidly obese people. This study of general practice data compared health costs and outcomes for people (...) with severe or morbid obesity who underwent surgery and those who did not. Surgery was associated with a reduced chance of developing diabetes and an increased chance of remission in people with diabetes. It was more cost-effective – using NHS thresholds – for morbidly obese people who had diabetes, than for those without diabetes. Weight loss surgery either reduces the amount of food people can consume or the amount of energy they can absorb from food. A quarter of UK adults are obese, with 3.6% of women

NIHR Dissemination Centre2018

70. A scan may help decide if surgery is required as follow-on treatment for head and neck cancer

A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Signal - A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Dissemination Centre Discover Portal NIHR DC Discover A scan may help decide if surgery is required as follow-on treatment for head and neck cancer Published on 7 June 2016 People with head and neck cancer in the UK usually receive chemotherapy and radiotherapy followed by surgery. Using a scan (...) to assess cancer status after this first line chemoradiotherapy and only suggesting surgery to those with a clear indication led to similar survival rates, complications and fewer operations compared with planned cancer surgery for everyone. After receiving similar initial treatment, this trial compared routine neck dissection surgery to surgery only if the scan showed residual cancer 12 weeks after chemoradiotherapy. Head and neck surgery can be invasive and disfiguring, so doctors and patients alike

NIHR Dissemination Centre2018

71. A statin drug during admission for heart surgery did not prevent an irregular heart beat

A statin drug during admission for heart surgery did not prevent an irregular heart beat Signal - A statin drug during admission for heart surgery did not prevent an irregular heart beat Dissemination Centre Discover Portal NIHR DC Discover A statin drug during admission for heart surgery did not prevent an irregular heart beat Published on 14 July 2016 The statin, rosuvastatin, taken by adults before and after heart surgery, did not prevent atrial fibrillation or heart muscle injury compared (...) to placebo. Acute kidney injury was more common for adults who received rosuvastatin. Atrial fibrillation (AF) is a type of irregular heart rhythm which is relatively common after heart surgery. A previous review of published research suggested that atrial fibrillation might be half as common with perioperative atorvastatin therapy, but the evidence was not reliable. This large trial included 1,922 adults from a hospital in Hong Kong mostly awaiting coronary-artery bypass graft. Rosuvastatin 20mg daily

NIHR Dissemination Centre2018

72. Large trial finds no benefit from restricting limb blood supply before heart surgery

Large trial finds no benefit from restricting limb blood supply before heart surgery Signal - Large trial finds no benefit from restricting limb blood supply before heart surgery Dissemination Centre Discover Portal NIHR DC Discover Large trial finds no benefit from restricting limb blood supply before heart surgery Published on 18 January 2016 Early small studies suggested that a period of restriction of blood supply to the arm just before cardiac surgery might confer some protection (...) to the heart during surgery (please see ). The NIHR funded this large, multi-centre trial to investigate whether controlled restriction of blood circulation to the arm immediately before heart bypass surgery could reduce deaths, heart attacks or strokes as measured one year after the operation. This larger study found no benefit. Casting doubt on the reliability of the earlier, smaller trials and the review. Share your views on the research. Why was this study needed? Coronary heart disease – where

NIHR Dissemination Centre2018

73. Weight loss surgery for obesity can lead to substantial weight loss and improved health outcomes

Weight loss surgery for obesity can lead to substantial weight loss and improved health outcomes Signal - Weight loss surgery for obesity can lead to substantial weight loss and improved health outcomes Dissemination Centre Discover Portal NIHR DC Discover Weight loss surgery for obesity can lead to substantial weight loss and improved health outcomes Published on 9 February 2016 On average people lost 5 kg more in each of the first four months after weight loss surgery than those of a similar (...) weight who did not undergo surgery. The risks of developing type 2 diabetes and high blood pressure were reduced. Surgery was linked to reduced risk of heart disease and sleep-related breathing problems. Those entering the trial had an average BMI of 44.7 kg/m2. Rates of obesity are high in the UK, around a quarter of the adult population is obese, and rising every year. Obesity is linked with health conditions such as type 2 diabetes, which is expensive to manage and has a big impact on people’s

NIHR Dissemination Centre2018

74. Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications

Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications Stomach cancer surgery and enhanced recovery programmes (ERAS) Dissemination Centre Discover Portal NIHR DC Discover Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications Published on 18 July 2018 doi: Enhanced recovery programmes reduce length of hospital stay and associated healthcare costs after stomach cancer surgery (...) , with no impact on short-term mortality or post-operative complications. They also improved post-operative quality of life. The enhanced recovery approach includes a range of components designed to help people to recover more quickly and have better outcomes after surgery. These include optimising people's health preoperatively, attention to detail during anaesthesia and surgery, early return to feeding and encouraging people onto their feet as soon as possible afterwards. Enhanced recovery is already

NIHR Dissemination Centre2018

75. Gallbladder surgery through a single-incision is more risky than a multiple incision technique

Gallbladder surgery through a single-incision is more risky than a multiple incision technique Gallbladder surgery through a single-incision is more risky than a multiple incision technique Dissemination Centre Discover Portal NIHR DC Discover Gallbladder surgery through a single-incision is more risky than a multiple incision technique Published on 17 July 2018 doi: Single-incision keyhole gallbladder removal surgery carries increased risk of adverse events, such as puncturing the gallbladder (...) appropriate option. Share your views on the research. Why was this study needed? About 10 to 15% of adults are thought to have gallstones, but not everyone has symptoms. The gallbladder may be removed if gallstones are painful or cause complications. Most operations to remove the gallbladder are carried out by keyhole surgery. Access via multiple incisions is standard practice, although single incision access is an option. Adverse events include complications such as puncturing the gallbladder, excessive

NIHR Dissemination Centre2018

76. Alternative sedative reduces the risk of acute kidney injury following cardiac surgery

Alternative sedative reduces the risk of acute kidney injury following cardiac surgery Alternative sedative reduces the risk of acute kidney injury following cardiac surgery Dissemination Centre Discover Portal NIHR DC Discover Alternative sedative reduces the risk of acute kidney injury following cardiac surgery Published on 10 July 2018 doi: The sedative drug dexmedetomidine can reduce the risk of acute kidney injury when given during non-emergency cardiac surgery. Trial participants who (...) received dexmedetomidine were a third less likely to develop acute kidney injury than those receiving placebo or other treatments. There was no difference in mortality or length of hospital stay. This systematic review identified 10 studies of 1,575 participants. Surgical procedures included coronary artery bypass grafting with or without valve surgery and aortic vascular surgery. Dexmedetomidine was given before or shortly after surgery. Most participants were followed up for the duration

NIHR Dissemination Centre2018

77. Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery

Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Dissemination Centre Discover Portal NIHR DC Discover Fewer side-effects and similar benefits from shorter chemotherapy after bowel cancer surgery Published on 12 June 2018 A three-month course of chemotherapy after surgery for bowel cancer seems no less effective than the standard six-month course, and half (...) as many people suffered from nerve damage as a side-effect. Three-quarters of people survived to three years without disease progression on either treatment. This international trial, part funded by the NIHR, included over 6,000 people with high-risk stage II or III bowel cancer that had spread through the bowel wall or to nearby lymph nodes. Standard treatment after surgery is usually six months of an oxaliplatin-containing regimen. This study evaluated a shorter course. Oxaliplatin is known

NIHR Dissemination Centre2018

78. Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery

Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery Dissemination Centre Discover Portal NIHR DC Discover Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery Published on 5 June 2018 In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint (...) replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug. Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the risk of blood clots in the legs or lungs. This trial included over 3,000 adults who received rivaroxaban for the first

NIHR Dissemination Centre2018

79. Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs

Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs Dissemination Centre Discover Portal NIHR DC Discover Redesigning oral surgery with enhanced primary dental care, electronic referral and triage may save overall costs Published on 15 May 2018 An electronic referral system including consultant-led triage and an advanced (...) oral surgery service in primary care results in fewer people requiring oral surgery in hospital. It comes at a lower overall cost than the previous arrangement. About two-thirds of patients could be treated safely in enhanced primary settings rather than hospital. This NIHR-funded study implemented several changes, an electronic referral system which standardised and improved the level of information provided in referrals. Commissioners also provided funding for an advanced service provided

NIHR Dissemination Centre2018

80. Physiotherapy education before major abdominal surgery reduces lung complications

Physiotherapy education before major abdominal surgery reduces lung complications Physiotherapy education before major abdominal surgery reduces lung complications Dissemination Centre Discover Portal NIHR DC Discover Physiotherapy education before major abdominal surgery reduces lung complications Published on 3 April 2018 A physiotherapy session before planned abdominal surgery, explaining the importance of breathing exercises and sitting out of bed as soon after surgery as possible, halves (...) the risk of pneumonia. This trial compared the physiotherapy session with usual care which was provided to all 432 participants. This consisted of a leaflet given in the pre-operative outpatient clinic outlining the exercises, and physiotherapy input in the days after surgery. Just seven people would need to receive the additional 30-minute pre-operative physiotherapy session to prevent one lung complication. The study was carried out in Australia and New Zealand, where usual care may differ from

NIHR Dissemination Centre2018