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Limits of Evidence-based Surgery

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Abstract

Evidence-based medicine can be summarized as the use of current best evidence in the care of individual patients. When applied to surgical practice, it appears clearly that the concept of evidence-based medicine involves some limitations. To discuss these limits, the author went back over the terms of the evidence-based medicine definition. Limits are related to the low quantity and quality of randomized controlled trials and meta-analyses in surgery, the difficulties when critically appraising the literature and applying the results of evidence to individual patients, and bringing surgeons more willing to endorse the principles of evidence-based medicine. However all these limits can be overcome in the future, with the aim that evidence-based surgery will not be a passing fad.

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References

  1. SE Straus FA McAlister (2000) ArticleTitleEvidence-based medicine: a commentary on common criticisms Can. Med. Assoc. J. 163 837–841

    Google Scholar 

  2. DL Sackett WMC Rosenberg JAM Gray et al. (1996) ArticleTitleEvidence based medicine: what it is and what it isn’t B.M.J. 312 71–72

    Google Scholar 

  3. R. Horton (1996) ArticleTitleSurgical research or comic opera: questions but few answers Lancet 347 984 Occurrence Handle10.1016/S0140-6736(96)90137-3 Occurrence Handle8606606

    Article  PubMed  Google Scholar 

  4. K Slim M Haugh PL Fagniez et al. (2000) ArticleTitleTen-year audit of randomized trials in digestive surgery from Europe Br. J.Surg. 87 1472–1473

    Google Scholar 

  5. MJ Solomon RS. McLeod (1993) ArticleTitleClinical studies in surgical journals: have we improved? Dis Colon Rectum 36 43–48 Occurrence Handle8416778

    PubMed  Google Scholar 

  6. MN Wente CM Seiler W Uhl et al. (2003) ArticleTitlePerspectives of evidence-based surgery Dig. Surg. 20 263–269 Occurrence Handle10.1159/000071183 Occurrence Handle12748428

    Article  PubMed  Google Scholar 

  7. K. Slim (2000) ArticleTitleEvidence-based surgery: from concept to everyday practice Ann. Chir. 125 605–608 Occurrence Handle10.1016/S0003-3944(00)00249-2 Occurrence Handle11051688

    Article  PubMed  Google Scholar 

  8. MJ Solomon A Laxamana L Devore et al. (1994) ArticleTitleRandomized controlled trials in surgery Surgery 115 707–712 Occurrence Handle8197563

    PubMed  Google Scholar 

  9. JC Hall B Mills H Nguyen et al. (1996) ArticleTitleMethodological standards in surgical trials Surgery 19 466–472

    Google Scholar 

  10. JC Hall JL. Hall (2002) ArticleTitleRandomization in surgical trials Surgery 132 513–518 Occurrence Handle10.1067/msy.2002.125350 Occurrence Handle12324767

    Article  PubMed  Google Scholar 

  11. K Slim J Bousquet F Kwiatkowski et al. (1997) ArticleTitleAnalysis of randomised controlled trials in laparoscopic surgery Br. J. Surg. 84 610–614 Occurrence Handle10.1046/j.1365-2168.1997.02753.x Occurrence Handle9171743

    Article  PubMed  Google Scholar 

  12. A Thakur EC Wang TT Chiu et al. (2001) ArticleTitleMethodology standards associated with quality reporting in clinical studies in pediatric surgery journals J. Pediatr. Surg. 36 1160–1164 Occurrence Handle10.1053/jpsu.2001.25737 Occurrence Handle11479847

    Article  PubMed  Google Scholar 

  13. JI Curry B Reeves MD. Stringer (2003) ArticleTitleRandomized controlled trials in pediatric surgery: could we do better? J. Pediatr. Surg 38 556–559 Occurrence Handle10.1053/jpsu.2003.50121 Occurrence Handle12677565

    Article  PubMed  Google Scholar 

  14. S. Wiebe (2003) ArticleTitleRandomized controlled trials of epilepsy surgery Epilepsia 44 IssueIDSuppl 17 38–43 Occurrence Handle10.1046/j.1528-1157.44.s7.9.x

    Article  Google Scholar 

  15. DA Grimes KF. Schulz (1996) ArticleTitleMethodology citations and the quality of randomized controlled trials in obstetrics and gynecology Am. J. Obstet. Gynecol. 174 1312–1315 Occurrence Handle8623862

    PubMed  Google Scholar 

  16. M Bhandari F Morrow AV Kulkarni et al. (2001) ArticleTitleMeta-analyses in orthopaedic surgery: a systematic review of their methodologies J. Bone Joint Surg. Am. 83 1433–1435 Occurrence Handle10.1302/0301-620X.83B1.10986

    Article  Google Scholar 

  17. D Moher DJ Cook S Eastwood et al. (2000) ArticleTitleImproving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement Br. J. Surg. 87 1448–1454 Occurrence Handle10.1046/j.1365-2168.2000.01610.x Occurrence Handle11091231

    Article  PubMed  Google Scholar 

  18. MJ Solomon RS. McLeod (1995) ArticleTitleShould we be performing more randomised controlled trials evaluating surgical operations? Surgery 118 459–467 Occurrence Handle7652679

    PubMed  Google Scholar 

  19. P McCulloch I Taylor M Sasako et al. (2002) ArticleTitleRandomised trials in surgery: problems and possible solutions B.M.J. 324 1448–1451

    Google Scholar 

  20. MJ Solomon CK Pager JM Young et al. (2003) ArticleTitlePatient entry into randomised controlled trials of colorectal cancer treatment: factors influencing participation Surgery 133 608–613 Occurrence Handle10.1067/msy.2003.119 Occurrence Handle12796726

    Article  PubMed  Google Scholar 

  21. JM Young MJ. Solomon (2003) ArticleTitleImproving the evidence-base in surgery: evaluating surgical effectiveness A.N.Z. J. Surg. 73 507–510 Occurrence Handle10.1046/j.1445-1433.2003.02662.x

    Article  Google Scholar 

  22. S. Barton (2000) ArticleTitleWhich clinical studies provide the best evidence? B.M.J. 321 255–256

    Google Scholar 

  23. SH Downs N. Black (1998) ArticleTitleThe feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions J. Epidemiol. Community Health 52 377–384 Occurrence Handle9764259

    PubMed  Google Scholar 

  24. JJ Deeks J Dinnes R D’Amico et al. (2003) ArticleTitleEvaluating non-randomised intervention studies Health Technol. Assess. 7 1–173

    Google Scholar 

  25. K Slim E Nini D Forestier et al. (2003) ArticleTitleMethodological index for non-randomized studies (MINORS): development and validation of a new instrument A.N.Z. J. Surg. 73 712–716 Occurrence Handle10.1046/j.1445-2197.2003.02748.x

    Article  Google Scholar 

  26. RR MacLehose BC Reeves IM Harvey et al. (2000) ArticleTitleA systematic review of comparisons of effect sizes derived from randomised and non-randomised studies Health Technol. Assess. 4 1–154

    Google Scholar 

  27. W Rosenberg A. Donald (1995) ArticleTitleEvidence based medicine: an approach to clinical problem solving B.M.J. 310 1122–1126

    Google Scholar 

  28. Bergmann JF. Can one be a urologist without being familiar with the methodology of therapeutic trials? Prog. Urol. 1996;6:199–204

    Google Scholar 

  29. http://www.cche.net/usersguides/main.asp

  30. PM. Rothwell (1995) ArticleTitleCan overall results of clinical trials be applied to all patients? Lancet 345 1616–1619 Occurrence Handle10.1016/S0140-6736(95)90120-5 Occurrence Handle7783541

    Article  PubMed  Google Scholar 

  31. D. Mant (1999) ArticleTitleCan randomised trials inform clinical decisions about individual patients? Lancet 353 743–746 Occurrence Handle10.1016/S0140-6736(98)09102-8 Occurrence Handle10073531

    Article  PubMed  Google Scholar 

  32. PP Glasziou LM. Irwig (1995) ArticleTitleAn evidence based approach to individualising treatment B.M.J. 311 1356–1359

    Google Scholar 

  33. JM Young MJ Hollands J Ward et al. (2003) ArticleTitleRole of opinion leaders in promoting evidence-based surgery Arch. Surg. 138 785–791 Occurrence Handle10.1001/archsurg.138.7.785 Occurrence Handle12860762

    Article  PubMed  Google Scholar 

  34. R Aldrich L Kemp J Stewart Williams et al. (2003) ArticleTitleUsing socioeconomic evidence in clinical practice guidelines B.M.J. 327 1283–1285

    Google Scholar 

  35. Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine : how to practice and teach EBM, 2nd edition, Edinburgh, Churchill Livingstone, 2000

  36. G Salkeld MJ. Solomon (2003) ArticleTitleAn economic perspective on evidence-based patient choice in surgery A.N.Z. J. Surg. 73 427–430 Occurrence Handle10.1046/j.1445-2197.2003.t01-1-02648.x

    Article  Google Scholar 

  37. J. Bensing (2000) ArticleTitleBridging the gap: the separate worlds of evidence-based medicine and patient-centered medicine Patient Educ. Couns. 39 17–25 Occurrence Handle10.1016/S0738-3991(99)00087-7 Occurrence Handle11013544

    Article  PubMed  Google Scholar 

  38. MJ Solomon CK Pager A Keshava et al. (2003) ArticleTitleWhat do patients want? Patient preferences and surrogate decision making in the treatment of colorectal cancer Dis. Colon Rectum 46 1351–1357 Occurrence Handle10.1007/s10350-004-6749-0 Occurrence Handle14530674

    Article  PubMed  Google Scholar 

  39. RB. Haynes (1993) ArticleTitleWhere’s the meat in clinical journals? A.C.P. J. Club 119 A23–A24

    Google Scholar 

  40. M Schuster E McGlynn R Brook (1998) ArticleTitleHow good is the quality of health care in the United States? Milbank Q 76 517–563 Occurrence Handle10.1111/1468-0009.00105 Occurrence Handle9879302

    Article  PubMed  Google Scholar 

  41. R. Grol (2001) ArticleTitleSuccesses, failures in the implementation of evidence-based guidelines for clinical practice Med. Care 39 IssueIDSuppl.2 46–54 Occurrence Handle10.1097/00005650-200108002-00003

    Article  Google Scholar 

  42. JE Ward M Gattellari MJ. Solomon (2002) ArticleTitleManagement of patients with colorectal cancer: do Australian surgeons know the scientific evidence? Arch. Surg. 137 1389–1394 Occurrence Handle10.1001/archsurg.137.12.1389 Occurrence Handle12470106

    Article  PubMed  Google Scholar 

  43. SJ Haines JS. Nicholas (2003) ArticleTitleTeaching evidence-based medicine to surgical subspecialty residents J. Am. Coll. Surg. 197 285–289 Occurrence Handle10.1016/S1072-7515(03)00114-5 Occurrence Handle12892813

    Article  PubMed  Google Scholar 

  44. N. Black (1999) ArticleTitleEvidence-based surgery: a passing fad? World J. Surg 23 789–793 Occurrence Handle10.1007/s002689900581 Occurrence Handle10415204

    Article  PubMed  Google Scholar 

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Correspondence to Karem Slim M.D..

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Slim, K. Limits of Evidence-based Surgery. World J. Surg. 29, 606–609 (2005). https://doi.org/10.1007/s00268-005-7922-x

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