Surgery News - December 2007 - (Page 11)

DECEMBER 2007 • SURGERY NEWS VASCULAR Percentage of Ipsilateral Strokes Prevented For 5 Years After Carotid Endarterectomy 18.5% 11 Success of Carotid Endarterectomy Hinges on Gender, Timing of Surgery BY MITCHEL L. ZOLER Time from most recent symptom to CEA 9.8% 5.4% 0.8% ELSEVIER GLOBAL MEDICAL NEWS Else vier Global Medical Ne ws B A L T I M O R E — Gender and timing are two important determinants of success that are usually ignored in the surgical treatment of carotid artery disease. Such omissions result in subjecting patients to the risks of carotid endarterectomy despite their markedly reduced chances of benefiting from the intervention. Women and those patients treated after several weeks’ delay are much less likely to benefit from CEA than are men and those patients treated soon after a symptom (usually a transient ischemic attack), Dr. A. Ross Naylor said at the Vascular Annual Meeting. The stroke prevention guidelines that have been issued by national health agencies and medical societies use a “one-sizefits-all” approach, said Dr. Naylor, professor of vascular surgery at the University of Leicester (England). The validity of this approach is undermined by a careful analysis of data that were compiled from three major CEA trials that compared CEA to medical treatment only in a total of more than 6,000 patients. Data from the European Carotid Surgery Trial, the North American Symptomatic Carotid Endarterectomy Trial, and the Veterans Affairs Trial 309 were gathered for analysis by the Carotid Endarterectomy Trialists’ Collaboration (Lancet 2003;361:107-16). Dr. Naylor’s analysis of these data showed that among symptomatic patients with 50%-99% carotid stenosis, there was a marked gradation in the rate of ipsilateral strokes prevented during 5 years of followup that correlated with the delay between their most recent symptom and surgery. For example, among patients who underwent CEA within less than 2 weeks of their most recent symptom, the absolute rate of ipsilateral strokes prevented was 18.5%, an “absolutely colossal” rate, he said. In contrast, among patients who had a greater than 12-week delay between their symptomatic episode and surgery, the 5-year rate of ipsilateral strokes prevented was 0.8%. “I can’t think of any regulatory agency that would approve a treatment that prevented 8 out of every 1,000 events,” Dr. Naylor said. The danger from delaying surgery is most dramatic in women. In Dr. Naylor’s analysis, women with 70%-99% stenosis had about 40% of their ipsilateral strokes prevented during 5 years of follow-up when their surgery was done within 2 weeks of symptoms. But when surgery was done 2-4 weeks after symptoms, about 4% of strokes were prevented during 5 years of follow-up. When surgery was delayed beyond 4 weeks, virtually no strokes were prevented during follow-up. Among women with 50%-69% stenosis, the only subgroup that benefited from CEA comprised those who had surgery less than 2 weeks after symptoms; in this group, CEA prevented about 10% of strokes. Women with 50%-69% stenosis who had CEA done 2 weeks or more after symptoms had an increased number of strokes, compared with untreated women. Among men, delaying surgery was less important. In men with 70%-99% stenosis, early CEA prevented about 22% of strokes over 5 years, and in men with 50%-69% stenosis CEA within 2 weeks of symptoms prevented about 14% of strokes over 5 years. By comparison, when surgery was delayed more than 12 weeks, it prevented about 19% of ipsilateral strokes during 5-year follow-up in men with 70%-99% stenosis, and it prevented about 5% of long-term strokes in men with 50%-69% stenosis, Dr. Naylor said. ■ 4 to 12 weeks >12 weeks Note: Based on a study of 2,644 men and women with 50%-99% carotid stenosis. Source: Dr. Naylor ON-Q® labeled for enhanced pain relief indications Continuous, automatic flow of local anesthetic post-op delivers: • Significantly better pain relief than narcotics • Significantly less need for narcotics Outcomes validated in landmark pain relief study published in The Journal of the American College of Surgeons* Better patient outcomes across surgical specialties—gets patients on their feet faster BREAKING NEWS ON-Q infection prevention study results presented† Post-op data from a colorectal surgery study showed that use of the ON-Q® PainBuster® with ON-Q® SilverSoaker™ resulted in: • Surgical site infection rates more than halved (6.6% vs 14.6% for control group, n=289) • Hospital stays reduced by 2.3 days (6.1 days vs 8.4 days) More information is available at www.iflo.com. *Liu SS, Richman JM, Thirlby RC, Wu CL. Efﬁcacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized clinical trials. J Am Coll Surg. 2006;203:914-932. † Singh J, Hum M, Cohen S, et al; and the MISS Study Group. Multicenter infection surveillance study comparing two types of postoperative pain management, surgical site using ON-Q® SilverSoaker™ and local anesthetics vs. systemic narcotics following colorectal procedures. Paper presented at: 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 2007; Chicago IL. ON-Q is not labeled for reducing infection rates and is not intended as a treatment for existing infections. Rx Only. For a list of supporting studies, please visit www.iﬂo.com. As a physician, you are aware that risks are inherent in all medical devices. Please refer to the product labeling for information. 20202 Windrow Drive, Lake Forest, CA 92630 Phone: 800-448-3569/949-206-2700 I-Flow, ON-Q, and PainBuster are registered trademarks of I-Flow Corporation. Redeﬁning Recovery and SilverSoaker are trademarks of I-Flow Corporation. © 2007 I-Flow Corporation. All rights reserved. 10/2007 M1305382 Please visit us at www.iflo.com or call 800-448-3569. http://www.iflo.com http://www.iflo.com http://www.iflo.com http://www.iflo.com

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Surgery News - December 2007 Contents Breast Radiation Boost Cuts Cancer Recurrence Mortality Soars in Some Patients With Respiratory Distress New Codes Promote Alcohol Screening New Ideas News From the College: Quality Standards General Surgery: Helping Hand Trauma: Spleen Protocol

Surgery News - December 2007

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