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NIHR Signal Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile
People with long-term illness are just as likely to benefit from knee or hip surgery as those without. However, they are more likely to have complications following surgery and to be readmitted within three months. This study reviewed data from 70 studies to determine the chance of short-term harms and long-term benefits linked to 11 different co-existing health conditions (such as diabetes and cancer) following hip and knee replacement. Short-term outcomes included surgical complications, infe...
NIHR Signal Partial knee replacements may save costs compared with total knee replacements
Partial knee replacements, when performed by experienced surgeons, can save costs and improve quality of life compared with total knee replacements. Partial replacements for selected patients improve quality of life and savebetween £600 and £2,000 over the patient’s lifetime, depending on age and gender. Knee replacements are commonly performed for people with ongoing pain and poor function. If the damage is limited to one side of the knee, it may be suitable to replace just t...
NIHR Signal Joint infection after hip replacement is linked to some risk factors that could be modified
Ten years of National Joint Registry data show that many factors may increase the risk of joint infection following hip replacement. Less than 1 in 1,000 people on average needed revision surgery for infection per year. Several modifiable patient factors increased risk, such as obesity and diabetes. Using ceramic components, and approaching surgery from the back rather than the side of the hip, may slightly reduce infection risk. This NIHR-funded study analysed registry data for 623,253 hip re...
NIHR Signal Keyhole surgery is more effective than physiotherapy for hip impingement
Keyhole surgery to reshape the joint surfaces in people with hip impingement improves hip-related quality of life more than physiotherapy. In hip impingement, there is a painful restriction of the smooth movement of the ball of the femur inside the cup (acetabulum) of the pelvis. It mainly affects younger, active people. Observational studies have supported the use of keyhole surgery (arthroscopy), but there was a lack of high-quality evidence. This NIHR-funded study is the first trial to compa...
NIHR Signal Fewer wound hernias occur if mesh is used to reinforce abdominal aortic aneurysm surgery
Mesh reinforcement may result in patients developing fewer hernias at the incision site after aortic aneurysm surgery. This type of hernia is a common complication of midline (vertical) incisions and can cause pain and restrict everyday activities. Although using mesh was linked with fewer incisional hernias, this systematic review could not determine with any certainty whether this led to fewer later operations on the hernia. Reoperation carries extra risk, especially in people who have had an...
NIHR Signal Endovascular aortic repair (EVAR) surgery more beneficial for ruptured abdominal aortic aneurysms than open repair
EVAR surgery to repair a ruptured abdominal aortic aneurysm had a slightly better survival rate after three years than open repair surgery. The survival benefit in this trial wasn’t apparent 30 days after surgery, but those having EVAR did recover more quickly and went home sooner. This NIHR-funded study also found that EVAR is likely to be more cost-effective. An abdominal aortic aneurysm is a swelling in the main artery that runs from the heart through the abdomen. If it bursts, there i...
NIHR Signal Music can reduce pain and anxiety following surgery
Recorded music played before, during or after surgery in adults reduces self-reported post-operative pain and anxiety, compared with usual care. The average effect is equivalent to a reduction in anxiety of 21 percentage points and a 10 percentage point reduction in pain within a few days of surgery. It is thought that placebo and distraction effects probably play a role, but in this review music still improved pain when used for patients under a general anaesthetic. Nearly two-thirds of patie...
NIHR Signal Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated. This high-quality implementati...
NIHR Signal Varicose vein injections help new venous leg ulcers heal
For patients with leg ulcers caused by varicose veins, early intervention to treat the veins results in faster healing of ulcers than standard compression therapy alone. Researchers studied 450 people with open venous leg ulcers of 6 weeks to 6 months duration and varicose veins. Those assigned to have their veins treated within two weeks had healed ulcers in an average of 56 days, compared with 82 days for those who had treatment deferred for six months, or until after the ulcer had healed. I...
NIHR Signal Enhanced recovery programmes after stomach cancer surgery reduce hospital stay without increasing complications
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 improvepost-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 su...
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