The Impact of perioperative glutamine-supplemented parenteral nutrition on outcomes of patients undergoing abdominal surgery

This meta-analysis identified 16 RCTs with 773 patients. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving perioperative glutamine-supplemented nutrition (risk ratio 0.48). Authors concluded that it shortened the length of hospital stay and reduced the morbidity of post-operative infectious complications in patients undergoing abdominal surgery.

Yue C, Tian W, Wang W, et al. Am Surg 2013; 79(5): b506.

Short-term outcomes for open and laparoscopic midline incisional hernia repair: A randomized multicenter controlled trial: The ProLOVE Trial

This trial randomised patients with a midline incisional hernia of a maximum width of 10cm to either laparoscopic (LR, n=64) or open sublay (OR, n=69) mesh repair. Surgical site infections were 17 in the OR group compared with one in the LR group. The severity of complications did not differ between the groups. Postoperative pain or recovery at three weeks does not differ between LR and OR, but the LR results in less surgical site infections than the OR does.

Rogmark P, Petersson U, Bringman S, et al. Ann Surg. 2013 Apr 26.
[Epub ahead of print]

Simulation-based trial of surgical-crisis checklists

A total of 17 operating-room teams participated in 106 simulated surgical-crisis scenarios in a simulated operating room. Each team was randomly assigned to manage half the scenarios with a set of crisis checklists and the remaining scenarios from memory alone. Failure to adhere to lifesaving processes of care was less common during simulations when checklists were available (6% of steps missed vs. 23%). Every team performed better when the checklists were available. Of the participants, 97% reported that if one of these crises occurred while they were undergoing an operation, they would want the checklist used. Authors conclude that checklists for use during operating-room crises have the potential to improve surgical care.

Arriaga AF, Bader AM, Wong JM, et al. N Engl J Med. 2013; 368(3):b246

Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures

NICE has recommended vertebroplasty and kyphoplasty (without stenting) as possible treatment options for some people with spinal compression fractures caused by osteoporosis. This should be considered for patients with severe ongoing pain after a recent, unhealed fracture of the spine despite treatment for pain, when pain has been confirmed to be where the fracture is. NICE recommended vertebroplasty and kyphoplasty (without stenting) because they work better than other treatments available on the NHS. Although they also cost more than other treatments, this was justified by the benefits they provide.

NICE, April 2013

Computed tomographic colonography (CTC) versus colonoscopy for investigation of patients with symptoms suggestive of colorectal cancer (SIGGAR): a multicentre randomised trial

Patients with symptoms suggestive of colorectal cancer were randomly assigned to receive either colonoscopy (n=1072) or CTC (n=538).

One hundred and sixty (30·0%) patients in the CTC group had additional colonic investigation compared with 86 (8·2%) in the colonoscopy group. Almost half the referrals after CTC were for small (<10mm) polyps or clinical uncertainty, with low predictive value for large polyps or cancer. Detection rates of colorectal cancer or large polyps in the trial cohort were 11% for both procedures.

Authors conclude that guidelines are needed to reduce the referral rate after CTC. For most patients, however, CTC provides a similarly sensitive, less invasive alternative to colonoscopy.

Atkin W, Dadswell E, Wooldrage K, et al for the SIGGAR investigators. The Lancet 2013; 381(9873): b1193

Surgery versus physical therapy for a meniscal tear and osteoarthritis

This multicenter trial randomised 351 patients, with a meniscal tear and mild-to-moderate osteoarthritis, to surgery and post-operative physical therapy or to a standardised physical-therapy regimen. In the intention-to-treat analysis the mean improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score after six months was similar (20.9 points in the surgical group and 18.5 in the physical-therapy group). However, 30% of the patients who were assigned to physical therapy alone underwent surgery within six months.

Jeffrey N. Katz JN, Brophy RH, Chaisson CE. N Engl J Med 2013; 368: b1675

Systematic review and meta-analysis of the early and late outcomes of open and endovascular repair of abdominal aortic aneurysm

This study included 25,078 patients undergoing endovascular EVAR and 27,142 undergoing open repair for AAA. Patients who had EVAR had a lower 30-day or in-hospital mortality rate (1·3% vs. 4·7%) By two-year follow-up there was no difference in all-cause mortality (14·3% vs. 15·2%), or aneurysm-related mortality. A significantly higher proportion of patients undergoing EVAR required re-intervention and suffered aneurysm rupture. The authors conclude there is no long-term survival benefit for patients who have EVAR compared with open repair for AAA. There are also higher risks of re-intervention and aneurysm rupture after EVAR.

P. W. Stather, D. Sidloff, N. Dattani, E. et al. BJS 2013; 100(7): b863