Journal of Anesthesia

, Volume 26, Issue 4, pp 509–515 | Cite as

A comprehensive appraisal of meta-analyses focusing on nonsurgical treatments aimed at decreasing perioperative mortality or major cardiac complications

  • Massimo Zambon
  • Giuseppe Biondi-Zoccai
  • Elena Bignami
  • Laura Ruggeri
  • Alberto Zangrillo
  • Giovanni Landoni
Original Article

Abstract

Purpose

Millions of patients worldwide who undergo surgical procedures face significant morbidity and mortality risks. Several systematic reviews have been performed on ancillary treatments aimed at improving surgical outcomes, but their features and scholarly impact are unclear. We describe characteristics of meta-analyses on ancillary treatments aimed at improving surgical outcomes and explore factors associated with scholarly citations.

Methods

Systematic reviews published up to 2008 were searched without language restrictions in MEDLINE/PubMed. Reviews focusing on nonsurgical treatments aimed at decreasing mortality or major cardiac complications were included. Associations between content, quality, and bibliometric details and scholarly citations in several indexes were systematically appraised.

Results

From 2,239 citations, 84 systematic reviews were identified. Patients most commonly underwent cardiovascular surgery (40.2 %), and were tested for cardiovascular drugs (25.8 %), with placebo acting as control (38.1 %). Internal validity appeared largely robust, as most (50.5 %) reviews were at low risk of bias. Normalized yearly citations for the included reviews ranged between 5.6 in Google Scholar and 4.3 in Web of Science. Multivariable analysis showed that citations were significantly and positively associated with number of authors, North American corresponding author, number of studies included, number of patients included, noncardiothoracic surgical scope, explicit funding, and lack of competing interests (all p < 0.05).

Conclusions

Systematic reviews currently represent a key element in defining state of the art ancillary treatments of patients undergoing surgery. However, the citation success of available meta-analyses is not significantly associated with prognostically relevant findings or quality features.

Keywords

Anesthesia Meta-analysis Mortality Myocardial infarction Overview Surgery Systematic review 

Supplementary material

540_2012_1372_MOESM1_ESM.doc (152 kb)
Online only table 1 (DOC 152 kb)
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Online only table 2 (DOC 136 kb)
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Online only table 3 (DOC 133 kb)
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Online only table 4 (DOC 30 kb)
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Online only table 5 (DOC 35 kb)
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Online only table 6 (DOC 36 kb)
540_2012_1372_MOESM7_ESM.tif (157 kb)
Bland–Altman plots appraising the difference between citations in Institute for Scientific Information Web of Science and Scopus (top panel) and the difference between citations in Institute for Scientific Information Web of Science and Google Scholar (bottom panel). (TIFF 157 kb)

References

  1. 1.
    Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Publishing Group; 2001.CrossRefGoogle Scholar
  2. 2.
    Glass G. Primary, secondary and meta-analysis of research. Educ Res. 1976;5:3–8.Google Scholar
  3. 3.
    Dixon E, Hameed M, Sutherland F, Cook DJ, Doig C. Evaluating meta-analyses in the general surgical literature: a critical appraisal. Ann Surg. 2005;241:450–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Guyatt G, Rennie D, Meade M, Cook D. Users’ guides to the medical literature. A manual for evidence-based clinical practice. Chicago: AMA Press; 2002.Google Scholar
  5. 5.
    Biondi-Zoccai GG, Agostoni P, Abbate A. Parallel hierarchy of scientific studies in cardiovascular medicine. Ital Heart J. 2003;4:819–20.PubMedGoogle Scholar
  6. 6.
    Patsopoulos NA, Analatos AA, Ioannidis JP. Relative citation impact of various study designs in the health sciences. JAMA. 2005;293:2362–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Glasziou P, Djulbegovic B, Burls A. Are systematic reviews more cost-effective than randomised trials? Lancet. 2006;367:2057–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Biondi-Zoccai GG, Lotrionte M, Abbate A, Testa L, Remigi E, Burzotta F, Valgimigli M, Romagnoli E, Crea F, Agostoni P. Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study. BMJ. 2006;332:202–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Biondi-Zoccai G. Duplicate meta-analyses on coronary bifurcation strategies: when more is less? EuroIntervention. 2010;6:181–3.PubMedCrossRefGoogle Scholar
  10. 10.
    Katz MH. Multivariable analysis: a practical guide for clinicians. Cambridge: Cambridge University Press; 1996.Google Scholar
  11. 11.
    Steyerberg EW, Eijkemans MJ, Habbema JD. Stepwise selection in small data sets: a simulation study of bias in logistic regression analysis. J Clin Epidemiol. 1999;52:935–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Biondi-Zoccai G, Romagnoli E, Agostoni P, Capodanno D, Castagno D, D’Ascenzo F, Sangiorgi G, Modena MG. Are propensity scores really superior to standard multivariable analysis? Contemp Clin Trials. 2011;32:731–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Guyatt GH, Mills EJ, Elbourne D. In the era of systematic reviews, does the size of an individual trial still matter? PLoS Med. 2008;5:e4.PubMedCrossRefGoogle Scholar
  14. 14.
    Levi M, Cromheecke ME, de Jonge E, Prins MH, de Mol BJ, Briët E, Büller HR. Pharmacological strategies to decrease excessive blood loss in cardiac surgery: a meta-analysis of clinically relevant endpoints. Lancet. 1999;354:1940–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Fergusson DA, Hébert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussières JS, Côté D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J. BART Investigators. A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319–31.PubMedCrossRefGoogle Scholar
  16. 16.
    Paladugu R, Schein M, Gardezi S, Wise L. One hundred citation classics in general surgical journals. World J Surg. 2002;26:1099–105.PubMedCrossRefGoogle Scholar
  17. 17.
    Auerbach AD, Goldman L. Beta-blockers and reduction of cardiac events in noncardiac surgery: scientific review. JAMA. 2002;287:1435–44.PubMedCrossRefGoogle Scholar
  18. 18.
    Crystal E, Connolly SJ, Sleik K, Ginger TJ, Yusuf S. Interventions on prevention of postoperative atrial fibrillation in patients undergoing heart surgery: a meta-analysis. Circulation. 2002;106:75–80.PubMedCrossRefGoogle Scholar
  19. 19.
    Crystal E, Garfinkle MS, Connolly SS, Ginger TT, Sleik K, Yusuf SS. Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery. Cochrane Database Syst Rev 2004;4:CD003611.Google Scholar

Copyright information

© Japanese Society of Anesthesiologists 2012

Authors and Affiliations

  • Massimo Zambon
    • 1
  • Giuseppe Biondi-Zoccai
    • 2
  • Elena Bignami
    • 1
  • Laura Ruggeri
    • 1
  • Alberto Zangrillo
    • 1
  • Giovanni Landoni
    • 1
    • 3
  1. 1.Department of Anesthesia and Intensive CareUniversità Vita-Salute San RaffaeleMilanItaly
  2. 2.Department of Medico-Surgical Sciences and BiotechnologiesSapienza University of RomeLatinaItaly
  3. 3.Department of Cardiothoracic Anesthesia and Intensive CareIstituto Scientifico San RaffaeleMilanItaly

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