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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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Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. Background We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or 28 days after surgery, whichever came first. We now report (...) the clinical outcomes at 6 months after surgery. Methods We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7.5 g per deciliter intraoperatively or postoperatively) or a liberal red-cell transfusion strategy (transfusion if the hemoglobin concentration was <9.5 g per deciliter intraoperatively or postoperatively when the patient was in the intensive care unit [ICU] or was <8.5 g per deciliter
Perioperative local anaesthesia for reducing pain following septal surgery. BACKGROUND: Septal surgery is a well-established procedure used to treat nasal obstruction due to deviation of the nasal septum, which is carried out under local or general anaesthesia. Local anaesthesia is used for postoperative pain control, but its effectiveness and safety are unclear. OBJECTIVES: To assess the effectiveness of perioperative local anaesthesia for reducing pain in septal surgery and to evaluate (...) surgery. We included studies comparing local anaesthesia versus no treatment/placebo. We also included studies comparing different types of local anaesthesia to each other (i.e. local injection, the addition of an anaesthetic agent to nasal packing, where used, and sphenopalatine ganglion block). DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. The primary outcome was postoperative pain intensity at 12, 24 and 48 hours measured by visual analogue scale
Intravenous versus inhalational maintenance of anaesthesia for postoperative cognitive outcomes in elderly people undergoing non-cardiac surgery. BACKGROUND: The use of anaesthetics in the elderly surgical population (more than 60 years of age) is increasing. Postoperative delirium, an acute condition characterized by reduced awareness of the environment and a disturbance in attention, typically occurs between 24 and 72 hours after surgery and can affect up to 60% of elderly surgical patients (...) with a target controlled infusion (TCI) allows plasma and effect-site concentrations to be calculated using an algorithm based on age, gender, weight and height of the patient.TIVA is a viable alternative to inhalational maintenance agents for surgical anaesthesia in elderly people. However, in terms of postoperative cognitive outcomes, the optimal technique is unknown. OBJECTIVES: To compare maintenance of general anaesthesia for elderly people undergoing non-cardiac surgery using propofol-based TIVA
Surgery versus stereotactic radiotherapy for people with single or solitary brain metastasis. BACKGROUND: Brain metastases occur when cancer cells spread from their original site to the brain and are a frequent cause of morbidity and death in people with cancer. They occur in 20% to 40% of people during the course of their disease. Brain metastases are also the most frequent type of brain malignancy. Single and solitary brain metastasis is infrequent and choosing the most appropriate treatment (...) is a clinical challenge. Surgery and stereotactic radiotherapy are two options. For surgery, tumour resection is performed using microsurgical techniques, while in stereotactic radiotherapy, external ionising radiation beams are precisely focused on the brain metastasis. Stereotactic radiotherapy may be given as a single dose, also known as single dose radiosurgery, or in a number of fractions, also known as fractionated stereotactic radiotherapy. There is uncertainty regarding which treatment (surgery
Surgery for women with pelvic organ prolapse with or without stress urinary incontinence. BACKGROUND: Pelvic organ prolapse (POP) is common in women and is frequently associated with stress urinary incontinence (SUI). In many cases however, SUI is present only with the prolapse reduced (occult SUI) or may develop after surgical treatment for prolapse (de novo SUI). OBJECTIVES: To determine the impact on postoperative bladder function of surgery for symptomatic pelvic organ prolapse (...) of the evidence ranged from low to moderate. The main limitations were risk of bias (especially blinding of outcome assessors), indirectness and imprecision associated with low event rates and small samples.POP surgery in women with SUIVaginal repair with vs without concomitant mid-urethral sling (MUS)A concomitant MUS probably improves postoperative rates of subjective SUI, as the evaluated clinical effect appears large (risk ratio (RR) 0.30, 95% confidence interval (CI) 0.19 to 0.48; 319 participants, two
Perioperative interventions in pelvic organ prolapse surgery. BACKGROUND: Pelvic organ prolapse (POP) affects as many as 50% of parous women, with 14% to 19% of women undergoing a surgical correction. Although surgery for the treatment of POP is common, limited supportive data can be found in the literature regarding the preoperative and postoperative interventions related to these procedures. The main goal of perioperative interventions is to reduce the rate of adverse events while improving (...) women's outcomes following surgical intervention for prolapse. A broad spectrum of perioperative interventions are available, and although the benefits of interventions such as prophylactic antibiotics before abdominal surgery are well established, others are unique to women undergoing POP surgeries and as such need to be investigated separately. OBJECTIVES: The aim of this review is to compare the safety and effectiveness of a range of perioperative interventions versus other interventions
Surgery versus thrombolysis for initial management of acute limb ischaemia. BACKGROUND: Both peripheral arterial thrombolysis and surgery can be used in the management of peripheral arterial ischaemia. Much is known about the indications, risks, and benefits of thrombolysis. However, whether thrombolysis works better than surgery for initial management of acute limb ischaemia remains unknown. This is the second update of the review first published in 2002. OBJECTIVES: To determine whether (...) thrombolysis or surgery is the more effective technique in the initial management of acute limb ischaemia due to thromboembolism. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE Ovid, Embase Ovid, CINAHL, AMED, and clinical trials registries up to 7 May 2018. SELECTION CRITERIA: All randomised controlled studies comparing thrombolysis and surgery for initial treatment of acute limb ischaemia. DATA
Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. BACKGROUND: Cleft lip and palate is one of the most common birth defects and can cause difficulties with feeding, speech and hearing, as well as psychosocial problems. Treatment of orofacial clefts is prolonged; it typically commences after birth and lasts until the child reaches adulthood or even into adulthood. Residual deformities, functional disturbances, or both, are frequently seen in adults (...) with a repaired cleft. Conventional orthognathic surgery, such as Le Fort I osteotomy, is often performed for the correction of maxillary hypoplasia. An alternative intervention is distraction osteogenesis, which achieves bone lengthening by gradual mechanical distraction. This review is an update of the original version that was published in 2016. OBJECTIVES: To provide evidence regarding the effects and long-term results of maxillary distraction osteogenesis compared to orthognathic surgery
Disc replacement is better than fusion in people needing surgery for neck disc disease Signal - Disc replacement is better than fusion in people needing surgery for neck disc disease Dissemination Centre Discover Portal NIHR DC Discover Disc replacement is better than fusion in people needing surgery for neck disc disease Published on 14 September 2015 As in the back, discs in the neck can degenerate and cause pain and nerve damage from pressure by the disc, in this case for cervical nerves (...) . In severe cases, where nerves are affected surgery is performed to relieve pain and numbness. This systematic review of trials found that replacing a damaged disc with an artificial substitute in the neck was better than removing the damaged disc and fusing the vertebrae either side. Compared with fusion, disc replacement improved neck function, reduced pain, and led to fewer further operations for up to five years after surgery. These findings are in line with 2010 NICE guidance on cervical disc
Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study. Background: Bariatric surgery improves glycemic control in patients with type 2 diabetes mellitus (T2DM), but less is known about microvascular outcomes. Objective: To investigate the relationship between bariatric surgery and incident microvascular complications of T2DM. Design: Retrospective matched cohort study from 2005 to 2011 with follow-up through September 2015. Setting: 4 (...) integrated health systems in the United States. Participants: Patients aged 19 to 79 years with T2DM who had bariatric surgery (n = 4024) were matched on age, sex, body mass index, hemoglobin A1c level, insulin use, diabetes duration, and intensity of health care use up to 3 nonsurgical participants (n = 11 059). Intervention: Bariatric procedures (76% gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) compared with usual care. Measurements: Adjusted Cox regression analysis
Meta-Analysis of Repeat Revascularization of Off-Pump and On-Pump Coronary Artery Bypass Surgery 29608874 2018 07 24 1552-6259 106 2 2018 Aug The Annals of thoracic surgery Ann. Thorac. Surg. Meta-Analysis of Repeat Revascularization of Off-Pump and On-Pump Coronary Artery Bypass Surgery. 526-531 S0003-4975(18)30408-9 10.1016/j.athoracsur.2018.02.068 There is an ongoing debate focusing on clinical outcomes after off-pump coronary artery bypass graft surgery (OPCABG) and on-pump coronary (...) artery bypass graft surgery (ONCABG). The objective of the present meta-analysis is to update and compare repeat revascularization rates between OPCABG and ONCABG procedures. Data sources including PubMed, EMBASE, Cochrane Library, and ISI Web of Knowledge were searched between 1966 and October 2017. Studies considered for inclusion should conform to the following criteria: prospective randomized clinical trials comparing OPCABG and ONCABG. Outcome should include repeat revascularization rate at the time of 1-month, 1
Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations 29794879 2018 06 22 1872-6623 2018 May 23 Pain Pain Should thoracic paravertebral blocks be used to prevent chronic postsurgical pain after breast cancer surgery? A systematic analysis of evidence in light of IMMPACT recommendations. 10.1097/j.pain.0000000000001292 The role of thoracic paravertebral block (PVB (...) ) in preventing chronic postsurgical pain (CPSP) after breast cancer surgery (BCS) has gained interest, but existing evidence is conflicting, and its methodological quality is unclear. This meta-analysis evaluates efficacy of PVB, compared with Control group, in preventing CPSP after BCS, in light of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) recommendations. Electronic databases were searched for randomized trials comparing PVB with Control group for CPSP
Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial 29975203 2018 08 14 1528-1175 129 3 2018 Sep Anesthesiology Anesthesiology Preoperative Fascia Iliaca Block Does Not Improve Analgesia after Arthroscopic Hip Surgery, but Causes Quadriceps Muscles Weakness: A Randomized, Double-blind Trial. 536-543 10.1097/ALN.0000000000002321 WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND (...) received an intraarticular injection of 10-ml ropivacaine 0.2% at procedure end. Primary study endpoint was highest pain score reported in the recovery room; other study endpoints were pain scores and opioid use 24 h after surgery. Additionally, quadriceps strength was measured to identify leg weakness. The analysis included 78 patients. Highest pain scores in the recovery room were similar in the block group (6 ± 2) versus placebo group (7 ± 2), difference: -0.2 (95% CI, -1.1 to 0.7), as was opioid
Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial 29932379 2018 06 22 1933-0693 2018 Jun 22 Journal of neurosurgery J. Neurosurg. Safety and efficacy of a novel neurosurgical enhanced recovery after surgery protocol for elective craniotomy: a prospective randomized controlled trial. 1-12 10.3171/2018.1.JNS171552 OBJECTIVE Although enhanced recovery after surgery (ERAS) programs have gained (...) in the ERAS group had a shortened duration of pain (1-2 days; 53% vs. 17%, OR 0.64, 95% CI 0.29-1.37, p = 0.0001). The urinary catheter was removed within 6 hours after surgery in 74% patients in the ERAS group (OR 400.1, 95% CI 23.56-6796, p < 0.0001). The time to first oral liquid intake was a median of 8 hours in the ERAS group compared to 11 hours in the control group (p < 0.0001), and solid food intake occurred at a median of 24 hours in the ERAS group compared to 72 hours in the control group (p
Intraoperative Methadone in Same-Day Ambulatory Surgery: A Randomized, Double-Blinded, Dose-Finding Pilot Study 29847382 2018 05 30 1526-7598 2018 May 25 Anesthesia and analgesia Anesth. Analg. Intraoperative Methadone in Same-Day Ambulatory Surgery: A Randomized, Double-Blinded, Dose-Finding Pilot Study. 10.1213/ANE.0000000000003464 Approximately 50 million US patients undergo ambulatory surgery annually. Postoperative opioid overprescribing is problematic, yet many patients report inadequate (...) pain relief. In major inpatient surgery, intraoperative single-dose methadone produces better analgesia and reduces opioid use compared with conventional repeated dosing of short-duration opioids. This investigation tested the hypothesis that in same-day ambulatory surgery, intraoperative methadone, compared with short-duration opioids, reduces opioid consumption and pain, and determined an effective intraoperative induction dose of methadone for same-day ambulatory surgery. A double-blind, dose
The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds 29803684 2018 05 27 1097-6809 2018 May 23 Journal of vascular surgery J. Vasc. Surg. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds. S0741-5214(18)30418-X 10.1016/j.jvs (...) .2018.01.060 Previous studies show conflicting results in wound healing outcomes based on angiosome direct perfusion (DP), but few have adjusted for wound characteristics in their analyses. We have previously shown that the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification correlates with wound healing in diabetic foot ulcers (DFUs) treated by a multidisciplinary team. The aim of this study was to compare WIfI classification vs DP and pedal arch patency as predictors
A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery 29754399 2018 07 18 1365-2648 2018 May 13 Journal of advanced nursing J Adv Nurs A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery. 10.1111/jan.13713 To explore
Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery 29870441 2018 06 05 1535-1386 100 11 2018 Jun 06 The Journal of bone and joint surgery. American volume J Bone Joint Surg Am Sustained Preoperative Opioid Use Is a Predictor of Continued Use Following Spine Surgery. 914-921 10.2106/JBJS.17.00862 Preoperative opioid use is known to increase the likelihood of complications and inferior outcomes following spine surgery. We evaluated the association (...) surgery discontinue these medications following surgical intervention. Among those who continue opioid use ≥90 days after the surgical procedure, the duration of preoperative use appears to be the most important predictor. Schoenfeld Andrew J AJ Department of Orthopaedic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Belmont Philip J PJ Jr Departments of Surgery (P.J.B.) and Preventive Medicine and Biostatistics (T.K
Readiness for Discharge After Foot and Ankle Surgery Using Peripheral Nerve Blocks: A Randomized Controlled Trial Comparing Spinal and General Anesthesia as Supplements to Nerve Blocks 29847387 2018 08 16 1526-7598 127 3 2018 Sep Anesthesia and analgesia Anesth. Analg. Readiness for Discharge After Foot and Ankle Surgery Using Peripheral Nerve Blocks: A Randomized Controlled Trial Comparing Spinal and General Anesthesia as Supplements to Nerve Blocks. 759-766 10.1213/ANE.0000000000003456 (...) Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. We hypothesized that general anesthesia (with nerve blocks) would lead to earlier readiness for discharge, compared to spinal anesthesia (with nerve blocks). All patients underwent ambulatory foot and ankle surgery, with a predicted case