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Evidence-based clinical management and utilization of new technology in European neurosurgery

  • Clinical Article - Neurosurgical Techniques
  • Published:
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Abstract

Background

Evidence-based medicine (EBM) has become one of the pillars of modern patient care. However, neurosurgery has always been an experience-based and technology-driven discipline, and it remains unknown to which extent European neurosurgeons follow high-level evidence-based recommendations.

Methods

We conducted a Web-based survey with a 15-item questionnaire about evidence-based clinical management and utilization of new technology among European neurosurgeons. Two different sum scores were calculated from the questions concerning clinical practice; evidence-based treatment score and new technology score. A high evidence-based treatment score means that more clinical conditions (i.e., study questions) were managed in compliance with the available highest levels of evidence from published clinical trials. A high new technology score reflects the use of a high number of modern tools in neurosurgical practice.

Results

A total of 239 neurosurgeons from 30 different European countries answered the questionnaire. There were large variations among European neurosurgeons in providing evidence-based care and in utilization of various modern tools. There were significant regional differences in evidence-based treatment scores and modern technology scores with higher scores in northern and western Europe. High-volume institutions were not associated with better evidence-based treatment scores, but had significantly higher new technology scores. There were significantly higher new technology scores at university hospitals and a trend towards higher evidence-based treatment scores compared to other hospitals.

Conclusions

Clinical management in neurosurgery does not always comply with the best available evidence and there are large regional differences in clinical management and in utilization of various modern tools. The position of evidence-based medicine in European neurosurgery seems weak and this may be a threat to the quality of care.

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References

  1. Bandopadhayay P, Goldschlager T, Rosenfeld JV (2008) The role of evidence-based medicine in neurosurgery. J Clin Neurosci 15:373–378

    Article  PubMed  Google Scholar 

  2. Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol 7:49–63

    Article  PubMed  Google Scholar 

  3. Barth M, Weiss C, Thomé C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 1: evaluation of clinical outcome. Spine 33:265–272

    Article  PubMed  Google Scholar 

  4. Barth M, Diepers M, Weiss C, Thomé C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 33:272–279

    Article  Google Scholar 

  5. Bartek J Jr, Hansen-Schwartz J, Bergdal O, Degn J, Romner B, Welling KL, Fischer W (2011) Alteplase (rtPA) treatment of intraventricular hematoma (IVH): safety of an efficient methodological approach for rapid clot removal. Acta Neurochir Suppl 111:409–413

    Article  PubMed  Google Scholar 

  6. Carragee EJ, Deyo RA, Kovacs FM, Peul WC, Lurie JD, Urrútia G, Corbin TP, Schoene ML (2009) Clinical Research: Is the Spine Field a Mine Field? Spine 34:423–430

    Google Scholar 

  7. Cenic A, Kachur E (2009) Lumbar discectomy: a national survey of neurosurgeons and literature review. Can J Neurol Sci 36:196–200

    PubMed  Google Scholar 

  8. Chandler WF, Knake JE, McGillicuddy JE, Lillehei KO, Silver TM (1982) Intraoperative use of real-time ultrasonography in neurosurgery. J Neurosurg 57:157–163

    Article  PubMed  CAS  Google Scholar 

  9. Curfman GD, Redberg RF (2011) Medical devices—balancing regulation and innovation. N Engl J Med 365:975–977

    Article  PubMed  CAS  Google Scholar 

  10. CRASH trial collaborators (2005) Final results of MRC CRASH, a randomized placebo-controlled trial of intravenous corticosteroids in adults with head injury: outcomes at 6 months. Lancet 365:1957–1959

    Article  Google Scholar 

  11. Dey M, Jaffe J, Stadnik A, Awad IA (2012) External ventricular drainage for intraventricular hemorrhage. Curr Neurol Neurosci Rep 12:24–33

    Article  PubMed  Google Scholar 

  12. Downing NS, Aminawung JA, Shah ND, Braunstein JB, Krumholz HM, Ross JS (2012) Regulatory review of novel therapeutics. Comparison of three regulatory agencies. N Engl J Med 366:2284–2293

    Article  PubMed  CAS  Google Scholar 

  13. Eftekhar B, Ghodsi M, Nejat F, Ketabchi E, Esmaeeli B (2004) Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneumocephalus: results of a clinical trial. J Neurosurg 101:757–761

    Article  PubMed  CAS  Google Scholar 

  14. Farah JO, Varma TRK (2008) Evidence-based neurosurgery – is it possible? Br J Neurosurg 22:461–461

    Article  PubMed  CAS  Google Scholar 

  15. Gaberel T, Magheru C, Parienti JJ, Huttner HB, Vivien D, Emery E (2011) Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis. Stroke 42:2776–2781

    Article  PubMed  Google Scholar 

  16. Haines SJ (2003) Evidence-based neurosurgery. Neurosurgery 52:36–47

    PubMed  Google Scholar 

  17. Hart MG, Grant R, Walker M, Dickinson H (2005) Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases Cochrane Database Syst Rev CD003292, vol 1

  18. Jakola AS, Myrmel KS, Kloster R, Torp SH, Lindal S, Unsgård G, Solheim O (2012) Comparison of a strategy favoring early surgical resection vs a strategy favoring watchful waiting in low-grade gliomas. JAMA 308:1881–1888

    PubMed  CAS  Google Scholar 

  19. Jannetta PJ (1968) The surgical binocular microscope in neurological surgery. Am Surg 34:31–34

    PubMed  CAS  Google Scholar 

  20. Kosugi Y, Watanabe E, Goto J, Watanabe T, Yoshimoto S, Kakakura K, Ikebe J (1988) An articulated neurosurgical navigation system using MRI and CT images. IEEE Trans Biomed Eng 35:147–152

    Article  PubMed  CAS  Google Scholar 

  21. Leksell L (1983) Stereotactic radiosurgery. J Neurol Neurosurg Psychiatry 46:797–803

    Article  PubMed  CAS  Google Scholar 

  22. Lunsford LD, Parrish R, Albright L (1984) Intraoperative imaging with a therapeutic computed tomographic scanner. Neurosurgery 15:559–561

    Article  PubMed  CAS  Google Scholar 

  23. Maconochie I, Ross M (2010) Head injury (moderate to severe). Clin Evid (online) 10:1210

    Google Scholar 

  24. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, for the Balliol Collaboration (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112

    Article  PubMed  Google Scholar 

  25. Pang T, Gray M, Evans T (2006) A 15th grand challenge for global public health. Lancet 367:284–286

    Article  PubMed  Google Scholar 

  26. Ratilal BO, Costa J, Sampaio C (2006) Antibiotic prophylaxis for surgical introduction of intracranial ventricular shunts. Cochrane Database Syst Rev CD005365, vol 3

  27. Ratilal BO, Costa J, Sampaio C, Pappamikail L (2011) Antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures. Cochrane Database Syst Rev CD004884, vol 8

  28. Rothoerl RD, Klier J, Woertgen C, Brawanski A (2003) Level of evidence and citation index in current neurosurgical publications. Neurosurg Rev 26:257–261

    Article  PubMed  Google Scholar 

  29. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS (1996) Evidence based medicine: what it is and what it isn’t. BMJ 312:71–72

    Article  PubMed  CAS  Google Scholar 

  30. Santarius T, Kirkpatrick PJ, Ganesan D, Chia HL, Jalloh I, Smielewski P, Richards HK, Marcus H, Parker RA, Price SJ, Kirollos RW, Pickard JD, Hutchinson PJ (2009) Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial. Lancet 374:1067–1073

    Article  PubMed  Google Scholar 

  31. Seiz M, Freyschlag CF, Schenkel S, Weiss C, Thomé C, Schmieder K, Stummer W, Tuettenberg J (2011) Management of patients with low-grade gliomas – A survey among German neurosurgical departments. Cent Eur Neurosurg 72:186–191

    Article  PubMed  CAS  Google Scholar 

  32. Solheim O, Cappelen J (2011) Bigger is bigger. Better is better. Acta Neurochir 153:1237–1243

    Article  PubMed  Google Scholar 

  33. Solheim O, Jakola AS, Gulati S, Johannesen TB (2012) Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study. J Neurosurg 116:825–834

    Article  PubMed  Google Scholar 

  34. Thomé C, Barth M, Scharf J, Schmiedek P (2005) Outcome after lumbar sequestrectomy compared with microdiscectomy: a prospective randomized study. J Neurosurg Spine 2:271–278

    Article  PubMed  Google Scholar 

  35. Webb AJ, Ullman NL, Mann S, Muschelli J, Awad IA, Hanley DF (2012) Resolution of intraventricular hemorrhage varies by ventricular region and dose of intraventricular thrombolytic: the Clot Lysis: Evaluating Accelerated Resolution of IVH (CLEAR IVH) program. Stroke 43:1666–1668

    Article  PubMed  Google Scholar 

  36. Yarascavitch BA, Chuback JE, Almenawer SA, Reddy K, Bhandari M (2012) Levels of evidence in the neurosurgical literature: more tribulations than trials. Neurosurgery 6:1131–1138

    Article  Google Scholar 

  37. Yaşargil MG, Krayenbühl H (1970) The use of the binocular microscope in neurosurgery. Bibl Ophthalmol 81:62–65

    PubMed  Google Scholar 

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Acknowledgments

We thank Bård Tommy Nilsen and Kyrre Svarva, Faculty of Social Sciences and Technology Management at the Norwegian University of Science and Technology, for their help with the Internet-based survey tool.

Conflicts of interests

None.

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Authors and Affiliations

  1. Department of Neurosurgery, St. Olavs University Hospital, Postboks 3250 Sluppen, 7006, Trondheim, Norway

    Clemens Weber, Asgeir S. Jakola, Sasha Gulati, Øystein P. Nygaard & Ole Solheim

  2. Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway

    Asgeir S. Jakola, Sasha Gulati & Øystein P. Nygaard

  3. National Center of Competence in Ultrasound and Image-Guided Therapy, Trondheim, Norway

    Asgeir S. Jakola & Ole Solheim

Authors
  1. Clemens Weber
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  2. Asgeir S. Jakola
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  3. Sasha Gulati
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  4. Øystein P. Nygaard
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  5. Ole Solheim
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Corresponding author

Correspondence to Clemens Weber.

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Ethical considerations

Patients or patient material were not involved in this study, therefore ethical approval was not obtained.

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Weber, C., Jakola, A.S., Gulati, S. et al. Evidence-based clinical management and utilization of new technology in European neurosurgery. Acta Neurochir 155, 747–754 (2013). https://doi.org/10.1007/s00701-013-1640-1

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  • DOI: https://doi.org/10.1007/s00701-013-1640-1

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