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Evidence-Based Surgery: Barriers, Solutions, and the Role of Evidence Synthesis

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Abstract

Background

Surgery is a rapidly evolving field, making the rigorous testing of emerging innovations vital. However, most surgical research fails to employ randomized controlled trials (RCTs) and has particularly been based on low-quality study designs. Subsequently, the analysis of data through meta-analysis and evidence synthesis is particularly difficult.

Methods

Through a systematic review of the literature, this article explores the barriers to achieving a strong evidence base in surgery and offers potential solutions to overcome the barriers.

Results

Many barriers exist to evidence-based surgical research. They include enabling factors, such as funding, time, infrastructure, patient preference, ethical issues, and additionally barriers associated with specific attributes related to researchers, methodologies, or interventions. Novel evidence synthesis techniques in surgery are discussed, including graphics synthesis, treatment networks, and network meta-analyses that help overcome many of the limitations associated with existing techniques. They offer the opportunity to assess gaps and quantitatively present inconsistencies within the existing evidence of RCTs.

Conclusions

Poorly or inadequately performed RCTs and meta-analyses can give rise to incorrect results and thus fail to inform clinical practice or revise policy. The above barriers can be overcome by providing academic leadership and good organizational support to ensure that adequate personnel, resources, and funding are allocated to the researcher. Training in research methodology and data interpretation can ensure that trials are conducted correctly and evidence is adequately synthesized and disseminated. The ultimate goal of overcoming the barriers to evidence-based surgery includes the improved quality of patient care in addition to enhanced patient outcomes.

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Authors and Affiliations

  1. Department of Surgery and Cancer, Imperial College London, 10th Floor, Queen Elizabeth The Queen Mother (QEQM) Building, St. Mary’s Hospital Campus, London, W2 1NY, UK

    George Garas, Amel Ibrahim, Hutan Ashrafian, Kamran Ahmed, Vanash Patel, Koji Okabayashi, Petros Skapinakis, Ara Darzi & Thanos Athanasiou

Authors
  1. George Garas
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  2. Amel Ibrahim
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  3. Hutan Ashrafian
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  4. Kamran Ahmed
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  5. Vanash Patel
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  6. Koji Okabayashi
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  7. Petros Skapinakis
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  8. Ara Darzi
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  9. Thanos Athanasiou
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Corresponding author

Correspondence to Thanos Athanasiou.

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Garas, G., Ibrahim, A., Ashrafian, H. et al. Evidence-Based Surgery: Barriers, Solutions, and the Role of Evidence Synthesis. World J Surg 36, 1723–1731 (2012). https://doi.org/10.1007/s00268-012-1597-x

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  • DOI: https://doi.org/10.1007/s00268-012-1597-x

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