Abstract
Background
The Appraisal of Guidelines Research and Evaluation (AGREE) II instrument was developed to evaluate the quality of clinical practice guidelines. Evidence suggests that development, reporting, and appraisal of guidelines on surgical interventions may be better informed by modification of the instrument.
Objective
We aimed to develop an AGREE II extension specifically designed for appraisal of guidelines of surgical interventions.
Methods
In a three-part project funded by the United European Gastroenterology and the European Association for Endoscopic Surgery, (i) we identified factors that were associated with higher quality of surgical guidelines, (ii) we statistically calibrated the AGREE II instrument in the context of surgical guidelines using correlation, reliability, and factor analysis, and (iii) we undertook a Delphi consensus process of stakeholders to inform the development of an AGREE II extension instrument for surgical interventions.
Results
Several features were prioritized by stakeholders as of particular importance for guidelines of surgical interventions, including development of a guideline protocol, consideration of practice variability and surgical expertise in different settings, and specification of infrastructures required to implement the recommendations. The AGREE-S—AGREE II extension instrument for surgical interventions has 25 items, compared to the 23 items of the original AGREE II instrument, organized into the following 6 domains: Scope and purpose, Stakeholders, Evidence synthesis, Development of recommendations, Editorial independence, and Implementation and update. As the original instrument, it concludes with an overall appraisal of the quality of the guideline and a judgement on whether the guideline is recommended for use. Several items were amended and rearranged among domains, and an item was deleted. The Rigor of Development domain of the original AGREE II was divided into Evidence Synthesis and Development of Recommendations. Items of the AGREE II domain Clarity of Presentation were incorporated in the new domain Development of Recommendations. Three new items were introduced, addressing the development of a guideline protocol, support by a guideline methodologist, and consideration of surgical experience/expertise.
Conclusion
The AGREE-S appraisal instrument has been developed to be used for assessment of the methodological and reporting quality of guidelines on surgical interventions.
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Change history
22 November 2022
A Correction to this paper has been published: https://doi.org/10.1007/s00464-022-09770-1
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Acknowledgements
Collaborative authorship: The GAP Consortium: Yasser Sami Abdel Dayem, Luca Bertolaccini, Pablo Alonso-Coello, Elie Akl, Manish Chand, John J Como, Gert J. de Borst, Salomone Di Saverio, Sameh Emile, Bang Wool Eom, Ramon Gorter, George Hanna, Kaisa Immonen, Quirino Lai, Nicolaas Lumen, Joseph L. Mathew, Alessandro Montedori, Martin Moya, Gianluca Pellino, Alvaro Sanabria, Athanasios Saratzis, Neil Smart, Dimitrios Stefanidis, Giovanni Zaninotto.
Funding
The Guideline Assessment Project (GAP) III received financial support from the United European Gastroenterology (UEG) and from the European Association for Endoscopic Surgery and Other Interventional Techniques (EAES), both non-profit organizations. The funders had no role in the design or development of this project.
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Ivan Florez and Melissa Brouwers are leads of the AGREE Consortium. Stavros A. Antoniou, Ivan D. Florez, Sheraz Markar, Patricia Logullo, Manuel López-Cano, Gianfranco Silecchia, George A. Antoniou, Sofia Tsokani, Dimitrios Mavridis and Melissa Brouwers have no conflicts of interest or financial ties to disclose. Detailed conflicts of interest statements of the authors are provided in http://osf.io/fau4d.
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The project was evaluated by the NHS/HSC Research Ethics Committee and ethics approval was waived.
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The authors obtained permission from the AGREE Consortium to reproduce parts of the AGREE II User’s Manual and 23-item Instrument.
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This article was updated to correct Alessandro Montedori's name.
The members of the GAP Consortium are listed in the Acknowledgements section.
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Antoniou, S.A., Florez, I.D., Markar, S. et al. AGREE-S: AGREE II extension for surgical interventions: appraisal instrument. Surg Endosc 36, 5547–5558 (2022). https://doi.org/10.1007/s00464-022-09354-z
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DOI: https://doi.org/10.1007/s00464-022-09354-z