Stikkordarkiv: kirurgi

Comparison of spinal fusion and nonoperative treatment in patients with chronic low back pain: long-term follow-up of three randomized controlled trials.

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Denne nevner at 11 år etter en «spinal fusion» operasjon er det ingen forskjell på de som ble operert og de som ikke ble operert. De konkluderer med at «spinal fusion» ikke bør utføres så lenge det er andre muligheter for behandling tilgjengelig.

http://www.ncbi.nlm.nih.gov/pubmed/24200413

CONCLUSIONS:

After an average of 11 years follow-up, there was no difference in patient self-rated outcomes between fusion and multidisciplinary cognitive-behavioral and exercise rehabilitation for cLBP. The results suggest that, given the increased risks of surgery and the lack of deterioration in nonoperative outcomes over time, the use of lumbar fusion in cLBP patients should not be favored in health care systems where multidisciplinary cognitive-behavioral and exercise rehabilitation programmes are available.

noen studier om placeboeffekt ved kirurgi

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Randomised Trial Support for Orthopaedic Surgical Procedures

Denne nevner at den samlede bevismengde for ortopediske inngrep viser at operasjoner ikke er bedre enn ikke-operativ behandling. Den nevner at kirurger forholder seg mindre (25%) til evidensbasert medisin enn andre leger (53%). Jeg legger merke til at kun 53% av avgjørelsene legene tar er evidensbaserte, den andre halvdelen av avgjørelser er det altså ikke evidens for.

The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.

Empirical research has shown that healthcare decisions on medical wards are more likely to be based on randomised trial evidence (53%) [5] than those on surgical wards (24% to 26%) [6]–[8].

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057075/

Randomised Trial Support for Orthopaedic Surgical Procedures

Denne nevner at i 50% av de undersøkte kirurgiske inngrepene er det ikke evidens for at det er bedre enn placebo.

Placebo controlled trial is a powerful, feasible way of showing the efficacy of surgical procedures. The risks of adverse effects associated with the placebo are small. In half of the studies, the results provide evidence against continued use of the investigated surgical procedures. Without well designed placebo controlled trials of surgery, ineffective treatment may continue unchallenged.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029190/