active surveillance for large numbers of prostate cancer patients

Moral of the story: With prostate screening methods being pretty crummy, people are finally starting to realize that low grade prostate cancer might be better treated (at least at first) simply with a watch and wait protocol. Biopsy and surgery have risks, which may be able to be postponed indefinitely.

Source: AMA Morning Rounds 3/29/2010

Major medical organization endorses active surveillance for large numbers of prostate cancer patients.

The Chicago Tribune (3/28, Graham) reported that "for the first time," active surveillance is "being endorsed for large numbers of men by a major medical organization: the National Comprehensive Cancer Network, an alliance of 21 leading cancer centers across the US." According to "new guidelines," the approach is recommended "for men deemed to have 'very low risk' prostate cancer and a life expectancy of less than 20 years," as well as for those men whose "prostate cancer is considered 'low risk' and" have a "life expectancy" of "less than 10 years." In other words, "almost 40 percent of the 192,000 men diagnosed with prostate cancer each year could qualify for active surveillance under those standards, said Dr. James Mohler," part of the "committee that prepared the guidelines."

        Researchers in Illinois conducting active surveillance studies. The Chicago Tribune (3/28, Graham) reported that last year, NorthShore University Health System began "recruiting men who are at least 60 years old with low-grade prostate cancer (Gleason score of 6 or less) and relatively low PSA scores (less than 10)" to find out which patients "can be managed safely with active surveillance." Adhering to "a slightly different protocol," University of Chicago researchers are also "tracking about 50 men with low-grade, low-risk prostate cancers." Meanwhile, a third trial, in which University of Toronto researchers "examined 453 men undergoing active surveillance over a period of up to 13 years," revealed that "men's risk of dying from prostate cancer during the study was one percent, while their risk of dying from another condition was 16 times as high," according to results "presented last year at meetings of the American Society of Clinical Oncology."

More hospitals offering therapeutic hypothermia for comatose survivors of cardiac arrest

Moral of the story: Hospitals are finally starting to get on the band wagon for offering hypothermic treatment after a heart attack

Source: AMA Morning Rounds 3/29/2010

More hospitals offering therapeutic hypothermia for comatose survivors of cardiac arrest.

USA Today (3/29, Marcus) reports that since the "American Heart Association issued recommendations and guidelines for inducing mild hypothermia in comatose survivors of cardiac arrest" in 2005, the "number of hospitals offering the treatment has climbed." Nearly "500 of about 5,000 hospitals across the country are doing it," and one expert calls therapeutic hypothermia "one of the most exciting and promising interventions for the treatment of cardiac arrest over the past 50 years." Still, "most proponents of cooling say they're surprised that the therapy hasn't caught on faster."

Moral of the story: Tanning beds are extremely dangerous, particularly early in life.

Source: AMA Morning Rounds 3/26/2010

FDA panel agrees on increased restrictions on tanning bed use.

ABC World News (3/25, story 9, 1:20 Muir) reported, "Tonight, there is late word from federal safety officials who are poised to crack down on indoor tanning beds. Twenty-eight million Americans tan indoors every year, and now a panel of experts is so alarmed by the dangers of skin cancer, it's making some pretty bold warnings." ABC senior medical editor Richard Besser, MD, explained that "a panel of experts put together by the Food and Drug Administration...reached broad agreement that there need to be increased restrictions on the use of these tanning beds for everyone under 18."

        The CBS Evening News (3/25, story 7, 0:15, Rodriguez) reported that panel's proposed new restrictions range "from requiring parental consent forms to banning the machines outright."

        But, because tanning beds themselves are not medical devices, the agency can only put restrictions on the lamps the beds use, the Wall Street Journal (3/26, Dooren) reports. In order to do that, the FDA could reclassify the lamps. That would force tanning bed manufacturers to get agency marketing approval of the beds.

        According to the AP (3/26, Perrone), "The FDA has regulated sunlamps for more than 20 years, but a recent report by the World Health Organization tied the devices to skin cancer, prompting a call for tougher rules." In fact, "the WHO analysis showed that" melanoma, "the deadliest form of skin cancer increases 75 percent in people who use tanning beds in their teens and 20s."

Higher percentage of women seeking contralateral prophylactic mastectomy, mostly unnecessary

Moral of the story: Contralateral prophylactic mastectomy is ONLY beneficial in some estrogen-receptor-negative cancers appearing before the age of 50.  This is otherwise NOT necessary.

Source: AMA Morning Rounds 3/9/2010

Higher percentage of women seeking contralateral prophylactic mastectomy.

The New York Times (3/8, Parker-Pope) "Well" blog reported, "The percentage of women asking to remove both breasts after a cancer diagnosis has more than doubled in recent years," according to research presented at the Society of Surgical Oncology annual meeting. Data indicate that contralateral prophylactic mastectomy is "more popular among women with the earliest, most curable forms of cancer." But, the current research showed "a slight survival benefit among a small subset of breast cancer patients -- women under 50 with early stage estrogen-receptor-negative tumors."

Oral contraceptives may reduce risk of death from any cause in women.

Moral of the story: Oral contraceptives decrease risk of death

Source: AMA Morning Rounds 3/12/2010, BMJ Press Release 3/12/2010

(4) Contraceptive pill not associated with increased long-term risk of death
(Research: Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study)
http://www.bmj.com/cgi/content/full/340/mar11_1/c927
Women in the UK who have ever used the oral contraceptive pill are less likely to die from any cause, including all cancers and heart disease, compared with never users, according to research published on bmj.com today.
The results show a slightly higher risk in women under 45 years old who are current or recent users of the pill. The authors stress that the effects in younger women disappear after about 10 years. Furthermore, the benefits in older women outweigh the smaller excess risks among younger women.
The study continues to find a higher rate of violent or accidental death among oral contraceptive users compared with never users. The authors are unable to explain this persistent finding.
In May 1968, the Royal College of General Practitioners' (RCGP) began the RCGP Oral Contraception Study, one of the world’s largest continuing investigations into the health effects of oral contraceptives.
Early reports from the RCGP study suggested an increased risk of death among oral contraceptive users, mainly due to an excess of strokes or other vascular problems among older women or those who smoked. Although a later report suggested that these effects disappear once the pill is stopped, at the time there were relatively few cases of different types of cancer.
These latest results, led by Professor Philip Hannaford from the University of Aberdeen, relate to the 46,000 recruited women, followed for up to nearly 40 years, creating more than a million woman-years of observation.
The results show that in the longer term, women who used oral contraception had a significantly lower rate of death from any cause, including heart disease and all cancers (notably bowel, uterine body and ovarian cancers) compared with never users.
This equates to 52 fewer deaths per 100,000 woman-years.
Slightly higher rates were found among younger women who had used oral contraception, with 20 more deaths per 100,000 among those younger than 30, and four more deaths per 100,000 among 30-39 year olds.
But by the age of 50, the benefits outweighed these modest risks, with 14 fewer deaths per 100,000 among 40-49 year olds; 86 fewer deaths per 100,000 for 50-59 year olds; 122 fewer deaths per 100,000 for 60-69 year olds; and 308 fewer deaths per 100,000 for 70+ year olds.
Hannaford says: "Many women, especially those who used the first generation of oral contraceptives many years ago, are likely to be reassured by our results. However, our findings might not reflect the experience of women using oral contraceptives today, if currently available preparations have a different risk than earlier products."
The authors conclude that their results, derived from a relatively healthy UK study group, show that "oral contraception is not significantly associated with an increased long-term risk of death . . . indeed a net benefit was apparent." However, they point out that "the balance of risks and benefits may vary globally, depending upon patterns of oral contraception usage and background risk of disease."
Contact:
Philip Hannaford, Centre of Academic Primary Care, University of Aberdeen, Scotland
Email p.hannaford@abdn.ac.uk

Oral contraceptives may reduce risk of death from any cause in women.

Bloomberg News (3/12, Cortez) reports that, according to findings published in the British Medical Journal, women who use oral contraceptives "were less likely to die of heart disease, cancer, or a range of other medical ailments." In fact, "women who took the pill were 12 percent less likely to die from any cause during the study." The study also showed that "the risk of death was slightly higher in women under age 45 who were current or recent users, though it abated after 10 years." Data indicated that "overall, there were 52 fewer deaths than expected for every 100,000 women taking the pill each year."

        MedPage Today (3/11, Fiore) reports that researchers "found lower rates of death from circulatory disease, ischemic heart disease, and other disease among women who'd used birth control pills," as well as "all cancers." Notably, "women on the pill did have higher rates of violent deaths," but "the researcher said they had no explanation for this association."

New reports suggest many Americans are being overtreated

Moral of the story: Americans are overtreated and this is both dangerous and costly.  People need to understand that more expensive and more intesive care is NOT better care.

Source: AMA Morning Rounds 3/15/2010

New reports suggest many Americans are being overtreated.

The AP (3/13, Tanner) reported, "A spate of recent reports suggests that many Americans are being overtreated." Research appearing in the New England Journal of Medicine "suggested that too many patients are getting angiograms...who don't really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section." Meanwhile, "the American Cancer Society cast more doubt on routine PSA tests for prostate cancer" as "experts dispute how much routine cancer screening saves lives." Still, "Not all doctors and advocacy groups agree with the criticism of screening. Many argue that it can improve survival chances and that saving even a few lives is worth the cost of routinely testing tens of thousands of people."

Moral of the story: Vaccines are GOOD. get vaccinated.

Source: AMA Morning Rounds 3/15/2010

US court rules thimerosal does not cause autism.

The New York Times (3/13, A11, McNeil) reported, "In a further blow to the antivaccine movement, three judges ruled Friday in three separate cases that thimerosal, a preservative containing mercury, does not cause autism." The rulings "are the second step in the Omnibus Autism Proceeding begun in 2002 in the United States Court of Federal Claims," which "combines the cases of 5,000 families with autistic children seeking compensation from the federal vaccine injury fund." The fund pays "families of children hurt by vaccines," but it "has never accepted that vaccines cause autism."

        The Los Angeles Times (3/13, Maugh, Zajac) reported, "The cases that three judges, called special masters, chose to rule on as test cases were considered among the strongest, so the outlook appears grim for others making the same claim." In one case, Special Master Denise K. Vowell wrote that "petitioners propose effects from mercury in [vaccines] that do not resemble mercury's known effects in the brain, either behaviorally or at the cellular level."

        "The cases had been divided into three theories about a vaccine-autism relationship for the court to consider," the AP (3/13, Schmid) reported. The court previously "rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine," and "a theory that certain vaccines alone cause autism." But, Friday's "ruling doesn't necessarily mean an end to the dispute...with appeals to other courts available."

Moral of the story: Donating a kidney is safe for the donor and obviously of huge benefit to the recipient. Donate today.

Source: AMA Morning Rounds 3/16/2010

Long-term health risk for kidney donors appears to be low.

The New York Times (3/16, Rabin) reports in "Vital Signs" that "having only one kidney does not appear to affect the long-term survival of live kidney donors, and the risk of dying from the surgery itself is very low, according to" a study published March 10 in the Journal of the American Medical Association. In a study of 80,347 US adult kidney donors "followed for an average of 6.3 years" whose "survival was compared with a group of 9,364" matched, healthy controls, researchers found that "live kidney donors were no more likely to die than the comparison group."

Smokers who quit may experience improved arterial health within one year.

Moral of the story: 1 YEAR! that is amazing. quit smoking and you will see benefits almost immediately

Source: AMA Morning Rounds 3/16/2010

Smokers who quit may experience improved arterial health within one year.

NBC Nightly News (3/15, story 8, 0:20, Williams) reported that there is a "new incentive for smokers to quit" considering a "big new study...says quitting can improve artery function" and "actually make blood vessels healthier."

        Indeed, the work coming out of the University of Wisconsin-Madison indicates that people tend to "pick up pounds" when they quit smoking, the AP (3/16, Marchione) reports. But "a year after kicking the habit, smokers' arteries showed signs of reversing a problem that can set the stage for heart disease," according to the paper in the Journal of the American College of Cardiology.

        In fact, the "benefit was the equivalent of a 14% reduction in the risk of cardiovascular disease," the Milwaukee Journal Sentinel (3/15, Fauber) noted. Investigators reached that conclusion by using "a test known as flow-mediated dilation, which uses ultrasound to look at the ability of the brachial artery to relax." Participants who "who quit smoking had an improvement in flow-mediated dilation from 6.2% to 7.2%."

Moral of the story: Warfarin has a very narrow therapeutic index and genotyping will help to prevent complications that are so very common.

Source: AMA Morning Rounds 3/17/2010

Data indicates warfarin genotyping may reduce hospitalization rates.

USA Today (3/17, Sternberg) reports, "Doctors who used a genetic test to personalize treatment with warfarin, the world's most widely prescribed blood thinner, cut their patients' hospitalization rates by almost a third," according to a presentation made during the American College of Cardiology meeting. The study, led by Medco Health Solutions' Robert Epstein, "marks the first nationwide attempt to incorporate genetic testing into the routine use of a drug whose effects vary so much from one person to another that it carries a 'black box' warning, the government's most urgent safety alert."

        Apparently, "too much warfarin can lead to bleeding, too little can lead to clots, and either one can kill," the AP (3/17, Marchione) reports. Even "certain foods can throw it off," and "up to 20 percent of patients wind up in the hospital in their first six months on the drug." But Mayo Clinic trial participants "given gene tests to set their initial warfarin dose had about a 30 percent lower risk of being hospitalized than similar patients whose doses were set by trial and error."

        And, "Epstein said that the cost of the genetic testing -- $250 to $400 -- would be justified by reduced hospitalization costs," HealthDay (3/16, Preidt) reported. Notably, the "study included 896 people who, shortly after beginning warfarin therapy, gave a blood sample or cheek swab that was analyzed for expression of two genes -- CYP2C9 and VKORC1 -- that revealed sensitivity to warfarin."

Survey finds many Americans drink, smoke, and don't exercise.

Moral of the story: Stop smoking, stop drinking, EXERCISE! Encourage others to do the same.

Source: AMA Morning Rounds 3/17/2010

Survey finds many Americans drink, smoke, and don't exercise.

USA Today (3/17, Hellmich) reports that, according to data from "the National Health Interview Survey, based on telephone interviews with 79,000 adults over three years," the US "is not a nation of teetotalers or regular exercisers." In fact, "61% of people in the USA drink alcohol," while "31% of people do enough regular leisure-time physical activity to get health benefits -- that is, moderate exercise for 30 minutes five times a week or vigorous activity for 20 minutes three times a week." Health statistician Charlotte Schoenborn, of the National Center for Health Statistics, said, "There has been no progress at all in increasing physical activity since we started doing this report in 1997."

        "Overall, researchers say that since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged," WebMD (3/16, Warner) reported. The survey also found that "one in five adults were smokers," while "six in 10 adults were obese or overweight," and "three in 10 adults averaged six hours of sleep or fewer per night."

Surgery Information and Videoes

If you are curious about a certain surgery check out this resource from a trusted source (NIH)

Aggressive measures to treat cholesterol, hypertension in diabetes not beneficial.

Moral of the story: The guidelines are correct.  Meet the recommended levels and you are good to go (if you have diabetes).

Source: AMA Morning Rounds 3/17/2010

Aggressive measures to treat cholesterol, hypertension in diabetes not beneficial.

The Los Angeles Times (3/15, Maugh) reports that for diabetics, "two new reports from a major nationwide trial called ACCORD released Sunday show that lowering either blood pressure or cholesterol levels below current guidelines do not provide additional benefit and, in fact, increase the risk of side effects." And, "a third arm of the study, released two years ago, shows that lowering blood sugar levels excessively actually increases the risk of heart disease." Despite being disappointing, "the findings 'reduce the cost and potential side effects of drug therapy' and mean that patients will not have to work as hard at reducing blood sugars, lipids, and blood pressure, said Dr. Denise Simons-Morton of the National Heart, Lung and Blood Institute, which funded the trial."

Spending on cancer care more than doubled since 1990.

Moral of the story: This is quickly becoming a moral issue about access to care due to its insane costs with a low benefit ratio in comparison to other treatments. People should take this into consideration.

Source: AMA Morning Rounds 3/17/2010

Spending on cancer care more than doubled since 1990.

USA Today (3/17, Szabo) reports that, according to research published in the Journal of the American Medical Association, "the cost of cancer treatment is 'skyrocketing' -- both for individual patients and the nation." Data indicate that "from 1990 to 2008, spending on cancer care soared to more than $90 billion from $27 billion." The trend may be due to advances in treatment that allow "older, frailer patients" to "have less invasive operations or more tightly focused radiation treatments...says" one analysis.

        The increase in spending on "cancer research and care...is straining the US health system and needs to be restrained, commentators said" in "six journal reports," Bloomberg News (3/17, Gibson) reports. Researchers suggested lowering the price of drugs by combining drug costs and other care in a single provider payment. They "also suggested...that doctors and hospitals should be grouped into accountable-care organizations" to "nudge physicians to act more cohesively."

        But, "in a commentary that accompanied" the "wide-ranging March 17 issue," MedPage Today (3/16, Frieden) reported that Susan Gapstur, PhD, MPH, and Michael Thun, MD, both of the American Cancer Society, "argued that comparing cancer rates in the US at any two time points 'can be misleading,'" because "such comparisons should 'take into account the more than 30% increase in the US population...since 1970.'" Gapstur and Thun concluded that "it is essential to move forward on multiple fronts simultaneously." AFP (3/16, Zeitvogel) also covered the story.

        Findings raise questions of cost-effectiveness of new colon cancer treatments. HealthDay (3/16, Preidt) reported, "New chemotherapy agents for metastatic colon cancer improve patient survival, but are costly," according to a study published online in the Archives of Internal Medicine. Researchers found that, "compared to those who received older chemotherapy agents, patients who received one or more of the six chemotherapy agents approved in the United States between 1996 and 2004 lived an average of 6.8 months longer." The investigators "calculated that the cost for each quality-adjusted life-year (a year of life in perfect health) gained was $99,100."

        Older colon cancer patients may be less likely to receive postoperative chemotherapy. The Los Angeles Times (3/16, Maugh) "Booster Shots" blog reported that a paper appearing in the Journal of the American Medical Association reveals that the "elderly are not treated as aggressively for colon cancer as younger people." UCLA researchers, alongside investigators at the Rand Corp., say that reality may be the result of "misguided compassion on the part of oncologists, who do not wish to subject older patients to the side effects associated with the most powerful treatments."

        There is also a pervasive feeling that older patients may not have much time left, according to Reuters (3/17, Allen). Some physicians are also leery of taking such measures because there is a dearth of data regarding chemo's efficacy in the elderly population.

Hearing aid with no externally visible components receives FDA approval.

Moral of the story: A hearing aid no one else can see.  cool. necessary?

Source: AMA Morning Rounds 3/18/2010

Hearing aid with no externally visible components receives FDA approval.

The Los Angeles Times (3/17, Healy) "Booster Shots" blog reported, "For several decades, people with hearing loss due to noise, viral infections or aging have had hearing aids to help maintain an aural tie to the world." Now, after a receiving approval from the FDA, "these patients will" have access to "a surgically implantable hearing system called Esteem." What's more, the "new device is considered to be the first hearing aid that has no externally visible components."

Moral of the story: Listen, ask questions, stay informed.

Source: AMA Morning Rounds 3/18/2010

Parents of children having surgery may not understand, remember risks of procedures.

HealthDay (3/17, Preidt) reported, "Even detailed counseling by doctors doesn't seem to help parents of children having surgery understand or remember all the risks of the procedures," according to research published in the Archives of Otolaryngology -- Head & Neck Surgery. In a study of "34 parents whose children were having a tonsillectomy or having tubes placed in their ears," researchers found that the parents "recalled about 58 percent of the nine surgical risks immediately after counseling and 57 percent on the day of the surgery." But, those "who had also received detailed information aids did better at remembering the risks both before and on the day of surgery."

Women with swine flu 13 times more likely to suffer critical illness if they are pregnant

Moral of the story: GET VACCINATED

(6) Women with swine flu 13 times more likely to suffer critical illness if they are pregnant
(Research: Critical illness due to 2009 A/H1N1 influenza 2009 in pregnant and postpartum women: population based cohort study)
http://www.bmj.com/cgi/content/full/340/mar18_3/c1279 (Editorial: Critical illness as a result of influenza A/H1N1 infection in pregnancy )
http://www.bmj.com/cgi/content/full/340/mar18_3/c1235
Pregnant women in Australia and New Zealand who had swine flu were 13 times more likely to be admitted to hospital with a critical illness, according to research published on bmj.com today.
The authors conclude that 11% of mothers and 12% of babies died as a result of being admitted to intensive care with swine flu. However they emphasise that given the small numbers included in their research, there are limits to the conclusions that can be drawn from the results.
It has already been established that pregnant women are at a higher risk of developing influenza complications. The recent swine flu pandemic was the first "to occur in an era of modern obstetric and intensive care management", says the study.
The research describes what happened to pregnant women with swine flu who were admitted to intensive care units (ICU) in Australia and New Zealand during the winter of 2009.
The authors, led by Dr Ian Seppelt from the Australian and New Zealand Intensive Care (ANZIC) Influenza Investigators in collaboration with the Australasian Maternity Outcomes Surveillance System, assessed the data relating to all women with swine flu who were pregnant or who had given birth in the last 28 days and were admitted to an ICU in Australia or New Zealand between 1 June and 31 August 2009.
During the study period, 209 women of child-bearing age (15 to 44) were admitted to an ICU with confirmed swine flu. Sixty-four of these (30.6%) were either pregnant or had recently given birth, 57 were admitted to an ICU in Australia and 7 to an ICU in New Zealand.
The results show that women who were more than 20 weeks pregnant were 13 times more likely to be admitted to an ICU than non-pregnant women who had swine flu. Forty-four (68.7%) of the women had to be put on ventilators to assist with breathing and of these, nine women (14.1%) needed further assistance to help oxygen reach their heart and lungs.
Overall seven (11%) of the mothers and seven (12%) of the babies died and Dr Seppelt argues that "although a mortality of 11% seems low when compared to usual outcomes of respiratory failure in intensive care … a maternal morality of 11% is high when compared with any other obstetric condition."
The authors highlight the fact that none of the women in the study had been immunised against seasonal flu despite recommendations that pregnant women should be immunised.
In an accompanying editorial, Dr Stephen Lapinsky from the Mount Sinai Hospital in Toronto, applauds the ANZIC team for their foresight and planning in investigating how swine flu affected pregnant women and those who recently gave birth.
He says the study "provides detailed data to enhance our understanding of maternal risk as well as the maternal and neonatal outcome".
Contacts:
Research: Ian Seppelt, Senior Staff Specialist, Department of Intensive Care Medicine, University of Sydney, Australia
Email seppelt@med.usyd.edu.au Editorial: Stephen Lapinsky, Site Director, ICU, Mount Sinai Hospital, Toronto, Canadabr/> Email stephen.lapinsky@utoronto.ca

Staples lead to higher risk of infection after joint surgery than traditional stitches

Moral of the story: with JOINT surgery staples are a BAD idea. Ask for traditional stitches (they take longer but decrease your risk of infection)

(1) Staples lead to higher risk of infection after joint surgery than traditional stitches
(Research: Sutures versus staples for skin closure in orthopaedic surgery: meta-analysis)
http://www.bmj.com/cgi/content/full/340/mar16_1/c1199 (Editorial: Staples for skin closure in surgery)
http://www.bmj.com/cgi/content/full/340/mar16_1/c403
Using metal staples to close wounds after orthopaedic (joint) surgery can lead to a greater risk of infection than using traditional nylon sutures, concludes a study published on bmj.com today.
Orthopaedic surgeons are therefore advised to reconsider their use of staples to close wounds after hip or knee surgery while further trials are carried out to confirm these findings.
Wound complications are one of the major sources of illness following orthopaedic procedures like knee and hip surgery. They can prolong a patient's stay in hospital or lead to re-admission. There is also a link between superficial wound infection and deep infection.
Orthopaedic surgeons use both metallic staples and nylon sutures to close wounds. Staples are regarded as quicker and easier than sutures, but some have suggested that staples are more likely to cause infection and may also be more expensive.
The optimal method of skin closure still remains unclear, so researchers at Norfolk and Norwich University Hospital analysed the results of six trials that compared the use of staples to sutures following orthopaedic procedures in adults.
The trials involved 683 wounds; 322 patients underwent suture closure and 351 staple closure. Overall, the risk of developing a superficial wound infection was over three times greater after staple closure than suture closure.
For hip surgery only, the risk of developing a wound infection was four times greater after staple closure than suture closure. There was no significant difference between sutures and staples in the development of inflammation, discharge, dehiscence (re-opening of a previously closed wound), necrosis and allergic reaction.
The authors point out that the quality of evidence was generally poor and they call for high quality, well designed trials to confirm their findings. However, based on the current evidence, they suggest that patients and doctors should think more carefully about the use of staples for wound closure after hip and knee surgery.
These results fit with evidence from other specialties, says Consultant Orthopaedic Surgeon, Bijayendra Singh, in an accompanying editorial. He points out that the most consistent benefit of staples is more rapid skin closure, yet the time saved is rarely more than two to three minutes. The saving may also be reduced by the increased costs of removing the staples (compared with absorbable stitches) and reduced even further by the costs of treating the increased number of infections.
Contacts:
Research: Toby Smith, Research Physiotherapist in Orthopaedics, Honorary Lecturer, Norfolk and Norwich University Hospital, Norwich, UK
Email: toby.smith@nnuh.nhs.uk Editorial: Bijayendra Singh, Consultant Orthopaedic Surgeon, Medway Foundation NHS Trust, Gillingham, UK
Email: bisortho@doctors.org.uk