The application of evidence-based medicine to the field of surgery.

University of Minnesota M.A. thesis. January 2012. Major: Philosophy. Advisor: Michael Root. 1 computer file (PDF); v, 58 pages, appendices A-B.Nonsurgical physicians have increasingly advocated for and adopted the use of data derived from well-done scientific studies (evidence-based medicine) to assist in decision making in patient care. Surgeons have, in general, resisted incorporating evidence-based medicine into their practices, and most surgical research has been based on expert opinions or findings from small groups of patients. This work will cover arguments for and against a hierarchy of evidence and for and against application of higher levels of evidence in the field of surgery

Collagen Tube Conduits in Peripheral Nerve Repair: A Retrospective Analysis

A chart review was conducted of all patients receiving NeuraGen® conduits from 2002 to 2007 at Regions Hospital, a level I trauma center. Ninety-six patients underwent 126 repairs using NeuraGen® conduits, and 64 patients were seen in follow-up. Repairs were largely of upper extremity sensory nerves but six were repairs of nerves elsewhere in the body. There were no intra-operative complications, but there were two minor postoperative complications and one postoperative pulmonary embolus. Forty of 126 repairs were lost to follow-up. Twenty-six of 126 repairs had follow-up with quantitative testing of nerve recovery (2-point discrimination, Semmes–Weinstein, or EMG testing), with 35% reporting improvement and 31% going on to a revision operation. Sixty of 126 repairs had qualitative testing performed (subjective or objective reporting of sensation or motor function), with 45% reporting improvement and 5% going on to a revision operation. Patients who went on to revision surgery were more likely to have undergone quantitative evaluation of sensation. Overall, sensory recovery was in the 35–45% range in our experience. Our results indicate that NeuraGen® collagen conduits can be used safely throughout the body