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Role of Systematic Reviews and Meta-analysis in Evidence-based Medicine

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Abstract

The overwhelming increase in the quantity of clinical evidence has led to detachment of the evidence and practice because new evidence can be integrated into clinical practice only after it has been critically appraised and synthesized on the basis of the existing evidence. Because many clinicians lack the skills and the time for such information processing, systematic reviews and meta-analyses, their quantitative counterparts, play an important role in health care. Well performed systematic reviews provide clinically relevant information for surgeons, abrogating the need to identify, read, and evaluate many individual studies. This article reviews the basic principles of meta-analysis, discusses its potential weaknesses such as heterogeneity and publication bias, and highlights special situations when dealing with surgical trials.

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References

  1. DL Sackett WM. Rosenberg (1995) ArticleTitleThe need for evidence-based medicine J. R. Soc. Med. 88 620–624 Occurrence Handle8544145

    PubMed  Google Scholar 

  2. B Millat A Fingerhut Y Flamant et al. (1999) ArticleTitleSurvey of the impact of randomised clinical trials on surgical practice in France Eur. J. Surg. 165 87–94 Occurrence Handle10.1080/110241599750007243 Occurrence Handle10192564

    Article  PubMed  Google Scholar 

  3. S Sauerland B Bouillon E. Neugebauer (2003) ArticleTitlePraktische Anwendung der EBM in der Chirurgie: Evidenz und Erfahrung Z. Arztl. Fortbild. Qualitatssich. 97 271–276 Occurrence Handle12891968

    PubMed  Google Scholar 

  4. W Uhl MN Wente MW. Büchler (2000) ArticleTitleChirurgisch-klinische Studien in der praktischen Durchführung Chirurg 71 615–625 Occurrence Handle10.1007/s001040051113 Occurrence Handle10948728

    Article  PubMed  Google Scholar 

  5. DE Barnes LA. Bero (1998) ArticleTitleWhy review articles on the health effects of passive smoking reach different conclusions J.A.M.A. 279 1566–1570 Occurrence Handle9605902

    PubMed  Google Scholar 

  6. EM Antman J Lau B Kupelnick et al. (1992) ArticleTitleA comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts: treatments for myocardial infarction J.A.M.A. 268 240–248 Occurrence Handle1535110

    PubMed  Google Scholar 

  7. KA L’Abbe AS Detsky K. O’Rourke (1987) ArticleTitleMeta-analysis in clinical research Ann. Intern. Med. 107 224–233 Occurrence Handle3300460

    PubMed  Google Scholar 

  8. S Sauerland T Sauerland G Antes et al. (2002) ArticleTitleMeta-Analysen von Quarks, Baryonen und Mesonen: eine “Cochrane Collaboration” in der Physik Z. Arztl. Fortbild. Qualitatssich. 96 95–98

    Google Scholar 

  9. E Neugebauer W. Lorenz (1989) ArticleTitleMeta-analysis: from classical review to a new refined methodology Theor. Surg. 4 79–85

    Google Scholar 

  10. Neugebauer, EAM, Lefering, R, McPeek, B et al. (1998) “Systematically reviewing previous work” In: Troidi, H, McKneally, MF, Mulder, DS (editors), Surgical Research: Basic Principles and Clinical Practice, 3rd ed., Springer, Berlin, pp 341-355

  11. IE Allen I. Olkin (1999) ArticleTitleEstimating time to conduct a meta-analysis from number of citations retrieved J.A.M.A. 282 634–635 Occurrence Handle10517715

    PubMed  Google Scholar 

  12. L McAuley B Pham P Tugwell et al. (2000) ArticleTitleDoes the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet 356 1228–1231 Occurrence Handle10.1016/S0140-6736(00)02786-0 Occurrence Handle11072941

    Article  PubMed  Google Scholar 

  13. M Egger T Zellweger-Zahner M Schneider et al. (1997) ArticleTitleLanguage bias in randomised controlled trials published in English and German Lancet 350 326–329 Occurrence Handle10.1016/S0140-6736(97)02419-7 Occurrence Handle9251637

    Article  PubMed  Google Scholar 

  14. D Moher DJ Cook S Eastwood et al. (1999) ArticleTitleImproving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement Lancet 354 1896–1900 Occurrence Handle10.1016/S0140-6736(99)04149-5 Occurrence Handle10584742

    Article  PubMed  Google Scholar 

  15. P Jüni DG Altman M. Egger (2001) ArticleTitleAssessing the quality of controlled clinical trials B.M.J. 323 42–46

    Google Scholar 

  16. P Jüni A Witschi R Bloch et al. (1999) ArticleTitleThe hazards of scoring the quality of clinical trials for meta-analysis J.A.M.A. 282 1054–1060 Occurrence Handle10493204

    PubMed  Google Scholar 

  17. JJ. Deeks (2002) ArticleTitleIssues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes Stat. Med. 21 1575–1600 Occurrence Handle10.1002/sim.1188 Occurrence Handle12111921

    Article  PubMed  Google Scholar 

  18. JPT Higgins SG Thompson JJ Deeks et al. (2003) ArticleTitleMeasuring inconsistency in meta-analyses B.M.J. 327 557–560

    Google Scholar 

  19. SG. Thompson (1994) ArticleTitleWhy sources of heterogeneity in meta-analysis should be investigated B.M.J. 309 1351–1355

    Google Scholar 

  20. PP Glasziou SL. Sanders (2002) ArticleTitleInvestigating causes of heterogeneity in systematic reviews Stat. Med. 21 1503–1511 Occurrence Handle10.1002/sim.1183 Occurrence Handle12111916

    Article  PubMed  Google Scholar 

  21. D Moher B Pham A Jones et al. (1998) ArticleTitleDoes quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 352 609–613 Occurrence Handle10.1016/S0140-6736(98)01085-X Occurrence Handle9746022

    Article  PubMed  Google Scholar 

  22. J Lau JP Ioannidis CH. Schmid (1998) ArticleTitleSumming up evidence: one answer is not always enough Lancet 351 123–127 Occurrence Handle10.1016/S0140-6736(97)08468-7 Occurrence Handle9439507

    Article  PubMed  Google Scholar 

  23. K. Dickersin (1990) ArticleTitleThe existence of publication bias and risk factors for its occurrence J.A.M.A. 263 1385–1389 Occurrence Handle2406472

    PubMed  Google Scholar 

  24. MK Krzyzanowska M Pintilie IF. Tannock (2003) ArticleTitleFactors associated with failure to publish large randomized trials presented at an oncology meeting J.A.M.A. 290 495–501 Occurrence Handle12876092

    PubMed  Google Scholar 

  25. M Egger G Davey Smith M Schneider et al. (1997) ArticleTitleBias in meta-analysis detected by a simple, graphical test B.M.J. 315 629–634

    Google Scholar 

  26. J LeLorier G Grégoire A Benhaddad et al. (1997) ArticleTitleDiscrepancies between meta-analyses and subseuqent large randomized, controlled trials N. Engl. J. Med. 337 536–542 Occurrence Handle10.1056/NEJM199708213370806 Occurrence Handle9262498

    Article  PubMed  Google Scholar 

  27. M Egger G Davey Smith DG Altman (2001) Systematic reviews in health care BMJ Publishing London

    Google Scholar 

  28. K Khan R Kunz J Kleijnen et al. ( 2003) Systematic reviews to support evidence-based medicine Royal Society of Medicine Press London

    Google Scholar 

  29. LA Stewart MKB. Parmar (1993) ArticleTitleMeta-analysis of the literature or of individual patient data: is there a difference? Lancet 341 418–422 Occurrence Handle10.1016/0140-6736(93)93004-K Occurrence Handle8094183

    Article  PubMed  Google Scholar 

  30. McCormack K, Scott NW, Go PM. et al. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst. Rev. 2003;CD001785

  31. F Song DG Altman AM Glenny et al. (2003) ArticleTitleValidity of indirect comparisons for estimating efficacy of competing interventions: empirical evidence from published meta-analyses B.M.J. 326 472–475

    Google Scholar 

  32. JG Lijmer BW Mol S Heisterkamp et al. (1999) ArticleTitleEmpirical evidence of design-related bias in studies of diagnostic tests J.A.M.A. 282 1061–1066 Occurrence Handle10493205

    PubMed  Google Scholar 

  33. S Sauerland E. Neugebauer (2000) ArticleTitleConsensus conferences must include a systematic search and categorization of the evidence Surg. Endosc. 14 908–910 Occurrence Handle10.1007/s004640000283 Occurrence Handle11080401

    Article  PubMed  Google Scholar 

  34. Sauerland S, Lefering R, Neugebauer EAM. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst. Rev. 2002;CD001546

  35. Sauerland S, Lefering R, Neugebauer E. Explaining heterogeneity in surgical trials by assessing learning-curves [abstract] In 2nd Symposium on Systematic Reviews. Oxford, Centre for Statistics in Medicine, 1999;65

  36. L Bero D. Rennie (1995) ArticleTitleThe Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care J.A.M.A. 274 1935–1938 Occurrence Handle8568988

    PubMed  Google Scholar 

  37. AR Jadad DJ Cook A Jones et al. (1998) ArticleTitleMethodology and reports of systematic reviews and meta-analyses: a comparison of Cochrane reviews with articles published in paper-based journals J.A.M.A. 280 278–280 Occurrence Handle9676681

    PubMed  Google Scholar 

  38. SD Emond PC Wyer MD Brown et al. (2002) ArticleTitleHow relevant are the systematic reviews in the Cochrane library to emergency medical practice? Ann Emerg. Med. 39 153–158 Occurrence Handle10.1067/mem.2002.120795 Occurrence Handle11823769

    Article  PubMed  Google Scholar 

Download references

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Correspondence to Stefan Sauerland M.D., M.P.H..

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Sauerland, S., Seiler, C.M. Role of Systematic Reviews and Meta-analysis in Evidence-based Medicine. World J. Surg. 29, 582–587 (2005). https://doi.org/10.1007/s00268-005-7917-7

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