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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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Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. This an update of the review first published in 2009.Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low molecular weight heparin (LMWH) administered during the in-hospital period is well-documented, but the optimal duration of prophylaxis after surgery remains controversial. Some studies suggest that patients undergoing (...) major abdominopelvic surgery benefit from prolongation of the prophylaxis up to 28 days after surgery.To evaluate the efficacy and safety of prolonged thromboprophylaxis with LMWH for at least 14 days after abdominal or pelvic surgery compared with thromboprophylaxis administered during the in-hospital period only in preventing late onset VTE.We performed electronic searches on 28 October 2017 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS and registered trials
WITHDRAWN: Peripheral nerve blocks for postoperative pain after major knee surgery. Major knee surgery is a common operative procedure to help people with end-stage knee disease or trauma to regain mobility and have improved quality of life. Poorly controlled pain immediately after surgery is still a key issue for this procedure. Peripheral nerve blocks are localized and site-specific analgesic options for major knee surgery. The increasing use of peripheral nerve blocks following major knee (...) surgery requires the synthesis of evidence to evaluate its effectiveness and safety, when compared with systemic, local infiltration, epidural and spinal analgesia.To examine the efficacy and safety of peripheral nerve blocks for postoperative pain control following major knee surgery using methods that permit comparison with systemic, local infiltration, epidural and spinal analgesia.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1, 2014), MEDLINE and EMBASE, from
Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings.In this multicenter randomized
Safe Delivery of paediatric ENT surgery in the UK- a national strategy 1 SAFE DELIVERY OF PAEDIATRIC ENT SURGERY IN THE UK: A NATIONAL STRATEGY A Report of a Combined Working Party of the British Association for Paediatric Otolaryngology (BAPO), ENT UK, The Royal College of Anaesthetists (RCoA) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) 3 Safe Delivery of Paediatric ENT Surgery in the UK: A National Strategy A Report of a Combined Working Party (...) Definitions Secondary Centre A secondary care centre is a district general hospital without paediatric intensive care facilities. It is recognised that some of the secondary care centres have a higher level of high dependency provision and therefore can accept a wider range of children for surgery. These are referred to as high acuity secondary centres and incorporate PICS Level 2 Critical Care. (2) Tertiary Centre A tertiary care centre is a hospital with full paediatric facilities including PICS Level 3
Perioperative FOLFOX 4 Versus FOLFOX 4 Plus Cetuximab Versus Immediate Surgery for High-Risk Stage II and III Colon Cancers: A Phase II Multicenter Randomized Controlled Trial (PRODIGE 22) Perioperative chemotherapy has proven valuable in several tumors, but not in colon cancer (CC).The aim of this study was to evaluate the efficacy and safety of perioperative chemotherapy in patients with locally advanced nonmetastatic CC.This is a French multicenter randomized phase II trial in patients (...) with resectable high-risk T3, T4, and/or N2 CC on baseline computed tomography (CT) scan. Patients were randomized to receive either 6 months of adjuvant FOLFOX after colectomy (control) or perioperative FOLFOX for 4 cycles before surgery and 8 cycles after (FOLFOX peri-op). In RAS wild-type patients, a third arm testing perioperative FOLFOX-cetuximab was added. Tumor Regression Grade (TRG1) of Ryan et al was the primary endpoint. Secondary endpoints were toxicity, perioperative morbidity, and quality
Maternal prepregnancy surgery and risk of neonatal abstinence syndrome in future newborns: a longitudinal cohort study Neonatal abstinence syndrome is increasingly prevalent, and may be related to opioid use disorders caused by postoperative prescriptions for pain control. We assessed the association of maternal prepregnancy surgery with risk of neonatal abstinence syndrome from opioid use disorders in future pregnancies.We conducted a longitudinal retrospective cohort study of 2 182 365 (...) deliveries in Quebec, Canada, between 1989 and 2016. The main exposure was maternal prepregnancy surgery. The main outcome measure was neonatal abstinence syndrome in offspring. We adjusted associations for maternal comorbidity and pregnancy characteristics using log-binomial regression models.The prevalence of neonatal abstinence syndrome in the cohort was 10.7 per 10 000 births. Compared with no surgery, prepregnancy surgery was associated with a risk ratio (RR) of neonatal abstinence syndrome of 1.63
Randomized Trial of Miniaturized Versus Standard Extracorporeal Circulation in Aortic Valve Surgery Complications related to extracorporeal circulation remain serious. Although a minimal invasive extra corporeal circulation (MiECC) system was developed to cope with these complications, its effectivity on patient-related outcomes such as blood loss remain uncertain. Therefore, the aim of this study is to compare MiECC to an advanced standard system with respect to blood loss.A total of 128 adult (...) patients undergoing elective isolated aortic valve replacement were enrolled in a randomized clinical trial. Patients who had undergone previous heart surgery and with preexisting kidney failure were excluded. The primary end point was postoperative blood loss after 12 hours and at drain removal. Secondary end points included intensive care and total length of stay and intubation time. At 1 hour and 12 hours after surgery, clinical laboratory data were determined. Early clinical outcomes and long-term
Perioperative Pregabalin and Intraoperative Lidocaine Infusion to Reduce Persistent Neuropathic Pain After Breast Cancer Surgery: A Multicenter, Factorial, Randomized, Controlled Pilot Trial Persistent postsurgical pain is defined as pain localized to the area of surgery of a duration of ≥2 months and is, unfortunately, a common complication after breast cancer surgery. Although there is insufficient evidence to support any preventative strategy, prior literature suggests the possible efficacy (...) of intravenous lidocaine and perioperative pregabalin in preventing persistent pain after surgery. To determine feasibility of conducting a larger definitive trial, we conducted a multicenter 2 × 2 factorial, randomized, placebo-controlled pilot trial of 100 female patients undergoing breast cancer surgery. Patients were randomized to receive an intraoperative lidocaine infusion (1.5 mg/kg bolus followed by 2 mg/kg/h) or placebo and perioperative pregabalin (300 mg preoperatively, 75 mg twice daily for 9
Safety of a Restrictive versus Liberal Approach to Red Blood Cell Transfusion on the Outcome of AKI in Patients Undergoing Cardiac Surgery: A Randomized Clinical Trial Safely reducing red blood cell transfusions can prevent transfusion-related adverse effects, conserve the blood supply, and reduce health care costs. Both anemia and red blood cell transfusion are independently associated with AKI, but observational data are insufficient to determine whether a restrictive approach to transfusion (...) can be used without increasing AKI risk.In a prespecified kidney substudy of a randomized noninferiority trial, we compared a restrictive threshold for red blood cell transfusion (transfuse if hemoglobin<7.5 g/dl, intraoperatively and postoperatively) with a liberal threshold (transfuse if hemoglobin<9.5 g/dl in the operating room or intensive care unit, or if hemoglobin<8.5 g/dl on the nonintensive care ward). We studied 4531 patients undergoing cardiac surgery with cardiopulmonary bypass who had
Adjunctive liraglutide treatment in patients with persistent or recurrent type 2 diabetes after metabolic surgery (GRAVITAS): a randomised, double-blind, placebo-controlled trial Many patients with type 2 diabetes do not achieve sustained diabetes remission after metabolic (bariatric) surgery for the treatment of obesity. Liraglutide, a glucagon-like peptide-1 analogue, improves glycaemic control and reduces bodyweight in patients with type 2 diabetes. Our aim was to assess the safety (...) and efficacy of liraglutide 1·8 mg in patients with persistent or recurrent type 2 diabetes after metabolic surgery.In the GRAVITAS randomised double-blind, placebo-controlled trial, we enrolled adults who had undergone Roux-en-Y gastric bypass or vertical sleeve gastrectomy and had persistent or recurrent type 2 diabetes with HbA1c levels higher than 48 mmol/mol (6·5%) at least 1 year after surgery from five hospitals in London, UK. Participants were randomly assigned (2:1) via a computer-generated
MitraClip transcatheter mitral valve repair in patients with moderate-to-severe or severe mitral regurgitation who are not eligible for surgery SHTG Advice | 1 SHTG Advice 05-19 August 2019 In response to an enquiry from the National Advisory Committee on Heart Disease MitraClip® transcatheter mitral valve repair in patients with moderate-to-severe or severe mitral regurgitation who are not eligible for surgery Advice for NHSScotland MitraClip® transcatheter mitral valve repair should (...) be considered for patients with moderate-to- severe (grade 3+) or severe (grade 4+) mitral regurgitation who are not eligible for open mitral valve repair surgery. Decisions should be made by a multi-disciplinary team with experience of performing this procedure, taking into account individual patients’ level of risk, comorbidities, preferences and quality of life. The annual procedure volume per centre for MitraClip® should be maximised to support optimal patient outcomes and ensure clinical experience
Systematic Review - Comparative Effectiveness of Multifocal, Accommodative, and Monofocal Intraocular Lenses for Cataract Surgery and Lens Replacement 4 July 2019 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services Research & Development Service Washington, DC 20420 Prepared by: Evidence Synthesis Program (ESP) Center West Los Angeles VA Medical Center Los Angeles, CA Paul G. Shekelle, MD, PhD, Director Comparative Effectiveness of Multifocal (...) , Accommodative, and Monofocal Intraocular Lenses for Cataract Surgery and Lens Replacement 4 Authors: Principal Investigator: Paul Shekelle, MD, PhD Co-Investigators: Sumitra S. Khandelwal, MD Jason Jun, MD, MPP Research Associates: Selene Mak, PhDc Roberta Shanman, MLS Jessica M. Beroes, BS Marika Suttorp Booth, MS Evidence Synthesis Program Intraocular Lenses for Cataract Surgery and Lens Replacement Evidence Synthesis Program i PREFACE The VA Evidence Synthesis Program (ESP) was established in 2007
HemaClear for bloodless surgical field during limb surgery HemaClear for bloodless surgical field during HemaClear for bloodless surgical field during limb surgery limb surgery Medtech innovation briefing Published: 15 July 2019 www.nice.org.uk/guidance/mib187 pathways Summary Summary The technology technology described in this briefing is HemaClear. It is used for limb exsanguination during limb surgery to provide a bloodless surgical field. The inno innovativ vative aspects e aspects (...) are that it is a single-use sterile device, which the company claims is quicker and simpler to use and reduces the number of adverse events compared with existing devices. It may also be used outside of the operating theatre (for example, in a procedure room for minor cases). The intended place in ther place in therap apy y would be as an alternative to the pneumatic tourniquet system in people needing limb surgery where a bloodless field is needed. The main points from the e main points from the evidence vidence
Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. This is an update of the review last published in 2011. It focuses on early postoperative enteral nutrition after lower gastrointestinal surgery. Traditional management consisted of 'nil by mouth', where patients receive fluids followed by solids after bowel function has returned. Although several trials have reported lower incidence (...) ) is associated with a shorter length of hospital stay (LoS), fewer complications, mortality and adverse events in patients undergoing lower gastrointestinal surgery (distal to the ligament of Treitz).We searched the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library 2017, issue 10), Ovid MEDLINE (1950 to 15 November 2017), Ovid Embase (1974 to 15 November 2017). We also searched for ongoing trials in ClinicalTrials.gov and World Health Organization International Clinical Trials
Impact of enhanced recovery after surgery on postoperative rehabilitation, inflammation, and immunity in gastric carcinoma patients: a randomized clinical trial. We determined the effects of enhanced recovery after surgery (ERAS) in patients undergoing radical surgery for gastric carcinoma. Sixty patients undergoing radical gastrectomy for gastric carcinoma in Lishui Hospital between March and October 2016 were randomized to receive either ERAS (30 patients) or conventional care (30 patients
Weekend effect among patients undergoing elective vascular surgery Several studies have described a higher mortality among patients admitted or operated during the weekend for various diseases. However, pooled data on patients undergoing elective vascular surgery procedures are sparse.The PubMed, Embase, Scopus, and Cochrane Library databases were systematically searched to identify eligible studies. Studies comparing short-term mortality (≤30 days) between patients undergoing elective vascular (...) surgery during the weekend and working days were included. When studies included patients undergoing mixed types of surgery, only the vascular surgery subgroups were evaluated. Urgent/emergency vascular procedures were excluded according to certain definitions provided by each study. Data were analyzed by using the StatsDirect Statistical software (Version 2.8.0, StatsDirect Ltd, Cambridge, UK).Overall, four retrospective studies including 131,201 patients undergoing elective vascular surgery
Paravertebral Dexmedetomidine in Video-Assisted Thoracic Surgeries for Acute and Chronic Pain Prevention Video-assisted thoracoscopic surgery (VATS) is considered as one of the minimally invasive surgeries. Early postoperative pain alleviation is very important to avoid complications, at the same time, proper early pain control is an established fact to decrease the incidence of chronic pain.To evaluate the efficacy of thoracic paravertebral block (PVB) by a bupivacaine/ dexmedetomidine mixture (...) on acute and chronic post-thoracoscopic surgery pain in patients undergoing VATS.A randomized prospective double-blinded trial.Assiut University Hospitals, Orman Cardiology Hospital.Sixty adult patients underwent elective VATS surgery under general anesthesia randomly allocated into 2 groups; Group I received thoracic PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and Group II received PVB with isobaric bupivacaine 0.5% (0.3 mL/kg) and dexmedetomidine (1 mcg/kg). Postoperative pain (at rest, with cough
Multicolumn spinal cord stimulation for predominant back pain in failed back surgery syndrome patients: a multicenter randomized controlled trial Despite optimal medical management (OMM), low back pain (LBP) can be disabling, particularly after spinal surgery. Spinal cord stimulation (SCS) is effective in reducing neuropathic leg pain; however, evidence is limited for LBP. This prospective, open-label, parallel-group trial randomized (1:1) failed back surgery syndrome (FBSS) patients (...) ) experienced SCS-related adverse events through 6 months, with 11.8% (12/102) requiring surgical reintervention. Adding multicolumn SCS to OMM improved pain relief, HRQoL, and function in a traditionally difficult-to-treat population of failed back surgery syndrome patients with predominant LBP. Improvements were sustained at 12 and 24 months.
Robot-assisted thoracic surgery Robot-assisted thoracic surgery - Health Technology Wales > Robot-assisted thoracic surgery Robot-assisted thoracic surgery Topic Status Incomplete Robot-assisted thoracic surgery. Summary Health Technology Wales researchers searched for evidence on the clinical and cost effectiveness of robot assisted thoracic surgery compared to other types of thoracic surgery. Based on the evidence identified, HTW’s Assessment Group concluded to progress this topic to Evidence
Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery Persistent postsurgical pain is common and affects quality of life. The hypothesis was that use of pregabalin and ketamine would prevent persistent pain after cardiac surgery.This randomized, double-blind, placebo-controlled trial was undertaken at two cardiac surgery centers in the United Kingdom. Adults without chronic pain and undergoing any elective cardiac surgery patients via sternotomy (...) were randomly assigned to receive either usual care, pregabalin (150 mg preoperatively and twice daily for 14 postoperative days) alone, or pregabalin in combination with a 48-h postoperative infusion of intravenous ketamine at 0.1 mg · kg · h. The primary endpoints were prevalence of clinically significant pain at 3 and 6 months after surgery, defined as a pain score on the numeric rating scale of 4 or higher (out of 10) after a functional assessment of three maximal coughs. The secondary outcomes