National quality improvement programmes need time and resources to have an impact
A large trial assessing the effectiveness of a UK-wide quality improvement programme did not show any difference in patient outcomes. However, the likely reasons for this were carefully investigated and provide some useful insights on implementation.
Several (37) quality improvement components were included in the ambitious package designed to reduce variation in care and improve outcomes for adults undergoing emergency abdominal surgery. There was no difference in survival at 30 days, length o...
More than 50% of hip replacements appear to last 25 years
Data from national registries and large case series showthat in those countries, around 85% of total hip replacements last for 15 years, with 58% lasting for 25 years. This means that those hip replacements have lasted last longer than was first thought. It is good news for an ageing population, as it should mean that the chances of needing a second hip operation are reducing.
However, it is not clear how directly relevant the results of this study are to the UK. The NIHR-funded study didn&rsqu...
More than 80% of total knee replacements can last for 25 years
Large data sets from national registries and case series show that about 82% of total knee replacements and 70% of partial (unicompartmental) knee replacements last for 25 years.
This NIHR-funded review of that data is the first to demonstrate longer-term effectiveness of these procedures. This means that the operation, which aims to relieve pain for osteoarthritis, may not need to be delayed to reduce the chance of a patient needing further surgery at a later date. It is an encouraging finding...
A laser eye procedure can be effective and safe if used early as treatment for glaucoma
Using a laser to improve drainage of fluid within the eye showed similar results to eye drops as a first-line treatment for adults with open angle glaucoma or ocular hypertension (raised pressure in the eye). It improved vision without increasing the risk of adverse events. It was preferred by patients and also associated with lower costs.
Current guidelines recommend that eye drops are used first to lower the pressure in the eye and slow the progression of glaucoma. Many patients find eye drop...
A traditional implant is as effective as more expensive newer types for people over 65 having a hip replacement
A commonly used, cheaper implant used in total hip replacement surgery is as effective as more expensive options for over-65s, a new study has found.
A range of prosthetic implants is used for hip replacement, including newer and more expensive options, with different surface materials and some that do not require cement. They may wear at different rates, and all can require further surgery if they become loose. This risk is greater for younger and more active patients.
This large NIHR-funded ...
Partial knee replacements have some short-term advantages compared to total knee replacements
Replacing one side of the knee, unicompartmental knee replacement, may result in shorter hospital stays, fewer short-term complications, faster recovery and better knee function than total knee replacements. However, about 8% need revision by five years - about two to three times the rate with total knee replacements.
People with pain and immobility from osteoarthritis that cannot be controlled by other treatments may be referred for knee surgery. If the damage is only to one side of the knee, ...
Better care of deteriorating patients has reduced US mortality after surgery
Improved management of deteriorating patients with surgical complications has reduced the number of deaths in US hospitals rather than it being due to fewer complications. Over the past 10 years, complication rates have remained fairly similar. It is the reduction in 'failure to rescue'that has made the main difference in mortality. It is unclear if this is because of earlier detection of patients who are deteriorating due to complications, or improved response and treatment.
Intravenous magnesium can reduce shivering in patients after surgery
An infusion of magnesium, given during or immediately after surgery, reduces the proportion of patients who experience shivering in the operating theatre or in recovery from 23% to 9.9%.
Shivering is unpleasant for the patient and may place strain on the cardiovascular system, as it increases oxygen use. A review of 64 trials found that intravenous magnesium was effective compared to placebo without any reported adverse effects.
In the UK, frequent temperature checks and active warming are rou...
Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy
For adults with bone or joint infection, many of whom had metal implants, beginning six weeks of oral antibiotics within seven days of intravenous treatment, was no worse than a regimen delivered wholly intravenously (IV). After one year, around 14% of both groups still had an infection, showing the difficulty of treatment, irrespective of the route of administration.
Although current practice suggests antibiotics should be given IV for bone and joint infections, for at least six weeks, this la...
Keyhole surgery may be better than physiotherapy for hip impingement
Adults with painful restriction of movement of their hip had greater improvements in their symptoms after arthroscopy (keyhole surgery) than those who had physiotherapy.
This NIHR-funded study included 222 people with hip pain and limited movement due to femoro-acetabular (hip) impingement but without a diagnosis of osteoarthritis. Their average age was 36 years. Half of the people who had surgery had significant benefit compared with a third of those having physiotherapy.
NICE has recommended...