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L Chagla

Publications and source records attributed to L Chagla.

4 recordsLinked to original sources
PubMed1997

Surgical practice is evidence based.

BACKGROUND: The quality of surgical research, and particularly the reluctance of surgeons to perform randomized controlled trials, has been criticized. The proportion of surgical treatments supported by satisfactory scientific evidence has not been evaluated previously. METHODS: A 1-month prospective audit was performed of 100 surgical inpatients admitted under two consultants in a general surgical/vascular unit at an urban teaching hospital; the main illness and interventions were agreed through group discussions in each case. The literature concerning the efficacy of each treatment was reviewed, and the evidence was categorized as: (1) supported by randomized controlled trial evidence; (2) sufficient other evidence of efficacy to make a placebo-controlled trial unethical; or (3) neither of the above. RESULTS: Of the 100 patients studied, 95 (95 per cent confidence interval (c.i.) 89-98) received treatment based on satisfactory evidence (categories 1 and 2) and, of these, 24 patients (95 per cent c.i. 17-35) received treatments based on randomized controlled trial evidence and 71 had treatments based on other convincing evidence (95 per cent c.i. 62-80). CONCLUSION: Inpatient general surgery is 'evidence based', but the proportion of surgical treatments supported by randomized controlled trial evidence is much smaller than that found in general medicine. Some reasons for this are clear, but the extent to which surgical practice needs to be reevaluated is not. Current methods for classifying and describing evidence in therapeutic studies need improvement.

Emergencies↗
PubMed1996

D2 gastrectomy: lessons from a prospective audit of the learning curve.

A 3-year prospective study of the learning curve for D2 gastrectomy was carried out by one surgeon beginning to perform the operation independently after intensive specialist training. Some 38 patients were treated; there were four postoperative deaths and 22 patients had complications. Postoperative morbidity decreased significantly with time (rS = -0.38, P = 0.02, 95 per cent confidence interval -0.62 to -0.07). The physiological component of POSSUM (Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) was significantly lower in the third year (median value 15, 16 and 14 for years 1, 2 and 3, n = 31, chi 2 = 7.5, 2 d.f., P = 0.02, Kruskal-Wallis test), but the operative POSSUM scores and the number of lymph nodes found were not decreased (median operative POSSUM score 19, 18 and 21, n = 31, chi 2 = 0.2, 2 d.f., P = 0.91, Kruskal-Wallis test). The results suggest a learning curve lasting about 18-24 months or 15 to 25 procedures before a plateau is reached. Improved results were associated with changes in case selection and operative tactics but not with reduced extent of lymphadenectomy. D2 gastrectomy should be restricted to specialist centres where adequate training and supervision can be provided during the learning curve.

Female↗