National Institiue for Health and Clinical Excellence

Annual Review - 2009/2010

All interventional procedures carry a certain amount of risk. Our guidance assesses this risk, based on the available evidence

Providing the safest and most effective treatment

NICE’s Interventional Procedures programme produces guidance on how safe a surgical procedure is and whether it works well enough for use in the NHS.

All interventional procedures carry a certain amount of risk. Our guidance assesses this risk, and any uncertainties, based on the evidence available, and by consulting clinical and patient experience.

It makes recommendations that either state how a procedure should be used in the NHS; that it should not be used because it is unsafe or clinically ineffective; or that it can only be used with special consent or in medical research.

In 2010/11, NICE issued guidance on 50 procedures in total. Soon NICE will be publishing its 400th piece of guidance since the programme was introduced in 2002.

Procedures covered include the diagnosis or treatment of patients by making a cut through the skin; the use of instruments such as endoscopes to enter the body; or those that feature equipment which uses energy sources such as electromagnetic radiation.

Some of the procedures considered are new to the NHS – others are more established but present some uncertainty about how safe they are, or how well they work.

Hand transplantation – a case study

Hand transplant surgery is an example of a rare and fairly new procedure that the programme recently considered. 

Intended for patients who have lost a hand through amputation after disease or serious injury, it seeks to provide them with a replacement limb from a recently deceased donor. The result of this is the patient has a hand that looks more natural than a mechanical prosthesis, and gains some sensation and movement.

The programme’s specialist committee examined the evidence for this procedure and produced guidance on it. The guidance, published in March 2011, recommends that healthcare professionals should explain the uncertainties and risks to all patients who are considering the treatment before they give their consent.

Professor Bruce Campbell, Chair of NICE's Interventional Procedures Advisory Committee, talks about the new guidance they published this year.

Are there any particular procedures the committee considered that stand out for being novel or particularly interesting?
“I would say the procedures that involve cooling patients (therapeutic hypothermia). Therapeutic hypothermia can be used for selected patients after cardiac arrest. A number of studies have shown that this increases the chance of survival for people who have had ventricular fibrillation arrest and who remain unconscious.

“In newborn babies with hypoxic brain injury, therapeutic hypothermia can increase the chance of survival and reduce the risk of disability. But it needs to be done by highly experienced clinical teams, in carefully selected newborn babies.”

What challenges do you think the team has faced this year, and how has it overcome them?
“A challenge has been deciding which of our large number of published pieces of guidance to review, and the value of review.

“We have introduced a new policy to consider procedures with ‘special arrangements’ guidance – that is, guidance reflecting inadequate evidence on safety and/or efficacy after three years. Specialists are asked about the procedures and a new literature search is done.

“We studied a sequence of 11 procedures which had guidance reviewed. We found that the evidence is now adequate in six procedures. This led to a change in the main recommendation for them from special arrangements to ‘normal arrangements’.

“The change in recommendation in over half of the procedures was based on newly available evidence on larger numbers of patients and longer follow-up times, and was supported by the opinions of Specialist Advisers.”