Deep brain stimulation for refractory epilepsy in adults [IPG678]

Deep brain stimulation for refractory epilepsy in adults [IPG678]
NICE Interventional procedures guidance 12 August 2020

• The procedure should only be done in neurosurgery centres that specialise in managing epilepsy.

Dynamic early identification of hip replacement implants with high revision rates.

Dynamic early identification of hip replacement implants with high revision rates. Study based on the NJR data from UK during 2004-2012.
PLoS One. 2020;15(8):e0236701. Published 2020 Aug 4. doi:10.1371/journal.pone.0236701

• The authors have developed an algorithm for early detection of poorly performing components in hip replacement surgery.

Abstract

The organisation of Oral and Maxillofacial services

The organisation of Oral and Maxillofacial services: Developing integrated networks of care
GIRFT and the British Association of Oral and Maxillofacial Surgeons (BAOMS) July 2020

• The advice pack supports the implementation of recommendations in the GIRFT national report on oral and maxillofacial surgery, published in November 2018, to improve efficiency by organising care through networks. These networks offer a range of benefits such as leading to more equitable access to treatment for patients and better outcomes, as well as making more effective use of clinicians’ time and skills.

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: theUK consensus position.

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: theUK consensus position.
Br J Cancer (2020). https://doi.org/10.1038/s41416-020-0980-x

• A consensus from UK clinicians with an interest in pancreatic cancer for management approaches that would minimise patient risk and accommodate for healthcare service restrictions.

Abstract

Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery.

Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery.
Clin Spine Surg. 2020;33(4):140-145. doi:10.1097/BSD.0000000000000982

• On the basis of the health-related quality of life outcomes, the cost-effectiveness of various spine surgeries can be determined, such as cervical fusions, lumbar fusions, microdiscectomies.

Abstract

Recovery of surgical services during and after COVID-19

Recovery of surgical services during and after COVID-19
Royal College of Surgeons updated 26 May 2020

• This page is regularly updated with new tools to help put this guidance into practice. 
• Includes Checklist for restarting elective services

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English NHS

Threshold for Computer- and Robot-Assisted Knee and Hip Replacements in the English National Health Service.
Value Health. 2020;23(6):719-726. doi:10.1016/j.jval.2019.11.011

• This study provides estimates of threshold prices for a range of potential improvements in the effectiveness of knee and hip replacement that could be realised from the adoption of computer- and robot-assisted knee and hip replacement.
• At a cost-effectiveness threshold of £20 000 per additional quality-adjusted life-year (QALY), the threshold price for a 5% improvement in post-primary unrevised quality of life (approximately equivalent to an additional two points in postoperative Oxford Knee Score [OKS]/Oxford Hip Score [OHS]) would be £10 000. The threshold price for a 50% reduction in the risk of revision would be £1000 per procedure.

Abstract

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.

Shoulder replacement surgery for osteoarthritis and rotator cuff tear arthropathy.
Cochrane Database of Systematic Reviews 21 April 2020, Issue 4. Art. No.: CD012879. DOI: 10.1002/14651858.CD012879.pub2.

• Conclusion: Although it is an established procedure, no high‐quality randomised trials have been conducted to determine whether shoulder replacement might be more effective than other treatments for osteoarthritis or rotator cuff tear arthropathy of the shoulder. We remain uncertain about which type or technique of shoulder replacement surgery is most effective in different situations.

Cost-effectiveness of Surgical Comanagement: A Systematic Review

Cost-effectiveness of Surgical Comanagement: A Systematic Review

Surgeon 2020 Apr 26;S1479-666X(20)30045-7. doi: 10.1016/j.surge.2020.04.001

• A search for research into the impact of surgical comanagement programmes on healthcare costs identified 8 studies, five of which reported savings while three three reported increased costs. Seven of the studies reported decreases in length of stay.

Abstract

Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes

Robotic Surgery in the Frail Elderly: Analysis of Perioperative Outcomes
Ann Surg Oncol 23 Apr 2020 doi: 10.1245/s10434-020-08475-w.

• Analysis of 982 patients (71 frail and 911 non-frail patients) from Memorial Sloan Kettering Cancer Center, New York, who underwent a robotic surgical procedure May 2007 - December 2016 confirms other research findings that the frail elderly have longer hospital stays and more complications after surgery than the general population.

Abstract

Specialised complex surgery for urinary incontinence and vaginal and uterine prolapse (16 years and above)

Service specification: Specialised complex surgery for urinary incontinence and vaginal and uterine prolapse (16 years and above)
NHS England 27 February 2020

• This service specification describes specialised complex surgery services for urinary incontinence and vaginal and uterine prolapse.

Hip replacements: do public or private providers do better?

Hip replacements: do public or private providers do better?
BMJ 2020;368:m362, 19 February 2020 doi: https://doi.org/10.1136/bmj.m362

• Analysis of health outcomes using EQ-5D after hip replacement or revision in  NHS and non-NHS hospitals.

Patient Reported Outcome Measures (PROMs) Finalised Hip & Knee Replacements, April 2018 – March 2019

Finalised Patient Reported Outcome Measures (PROMs) in England for Hip & Knee Replacements, April 2018 – March 2019
NHS Digital 13 February 2020

• The data includes improvement for revision surgery.
• Data by provider or CCG Click here to access the report.

National Vascular Registry 2019 Annual Report

National Vascular Registry 2019 Annual Report
Vascular Services Quality Improvement Programme 13 December 2019

• This report contains information on the process and outcomes of care provided by NHS vascular units during the three-years from 2016 to 2018 for patients undergoing:
• Lower limb bypass
• Lower limb angioplasty/stenting
• Major lower limb amputation
• Carotid endarterectomy
• Repair of aortic aneurysms, including elective infra-renal, ruptured infra-renal, and more complex aneurysms
• Also available on HQIP

Veteran patients tap in to mobile phone app (myrecovery)

Veteran patients tap in to mobile phone app (myrecovery)
Robert Jones and Agnes Hunt Orthopaedic Hospital News 13 November 2019

• The myrecovery app (https://www.myrecovery.ai/) is being trialled by patients of the Veterans’ Orthopaedic Service at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Shropshire. 
• The app includes videos from Surgeons, Physiotherapists and Nurses who offer tips and advice from patients, as well as providing them with a way to track their progress on the road to recovery.

National Clinical Improvement Programme Portal (GIRFT)

National Clinical Improvement Programme (NCIP)
Getting It Right First Time

• The National Clinical Improvement Programme (NCIP) portal is a digital tool that NHS consultants in England will use to review their personal patient outcomes data alongside comparable national and unit level data.
• Metrics are being developed for the following surgical specialties: cardiothoracic surgery, ENT, general surgery, neurosurgery, obstetrics and gynaecology, oral and maxillofacial surgery, ophthalmology, orthopaedics, paediatric surgery, spinal surgery, urology and vascular surgery.

Paediatric critical care and surgery in children review: Summary report

Paediatric critical care and surgery in children review: Summary report
NHS England 5 November 2019

• The aim of the review has been to identify an optimal model of care for providing sustainable, high quality, responsive Paediatric critical care (PCC) and surgery in children (SIC) services. 
• This document is the final report summarising the review. NHS England will now undertake the formal commissioning of these services and has developed guidance to support the development and running of PCC and SIC operational delivery networks, which is available through the Future NHS Collaboration Platform. [Permission required]

GIRFT - Ear,Nose and Throat Surgery

Ear,Nose and Throat Surgery
GIRFT 1 November 2019

• The GIRFT review of ENT services visited 126 units across the country. This report highlights a significant degree of unwarranted variation in a number of key areas in delivery of ENT surgery and suggests how the many examples of good practice in the delivery of ENT services could be adopted in order to improve patient care and outcomes.
• The report makes 23 recommendations ranging from increasing day case surgery, networks for out-of-hours provision, improve the procurement of devices and consumables, consider including Patient Reported Outcome Metrics (PROMs) for ENT and head and neck surgery and implement the GIRFT 5 point plan for reducing litigation costs.

TAVR for low-risk severe aortic stenosis: is this the end of surgical valve replacement?

TAVR for low-risk severe aortic stenosis: is this the end of surgical valve replacement?
BMJ Evidence-Based Medicine 1 November 2019. doi: 10.1136/bmjebm-2019-111259 [NHS OpenAthens required]

• New trials, PARTNER 3 and Evolut Low Risk, showed promising results for transcatheter aortic valve replacement for low-risk surgical patients with severe aortic stenosis. However, there remain caveats to its use in this population in clinical practice.

Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR

Robotic-assisted surgery compared with laparoscopic resection surgery for rectal cancer: the ROLARR RCT.
Efficacy Mech Eval 2019;6(10) September 2019

• There is insufficient evidence to conclude that robotic rectal cancer surgery compared with laparoscopic surgery reduces the risk of conversion to laparotomy, and overall it results in comparable outcomes and it was more expensive.

See also:
NIHR Signal Robotic surgery for rectal cancer produces similar results to keyhole surgery