Advertisement

Surgery pp 21-35 | Cite as

Evidence-Based Surgery

  • Robin S. McLeod

Abstract

The term evidence-based medicine was coined by Sackett and colleagues in the 1980s. They defined it as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”1 The practice of evidence-based medicine means integrating individual clinical expertise with the best-available clinical evidence from systematic research. In short, evidence-based medicine means systematically searching for the best evidence rather than relying on expert opinion or anecdotal experience. In addition, Sackett and colleagues recognized the importance of the clinical expertise that most physicians possess and were explicit in stating that the evidence must be integrated with clinical acumen. Finally, the preferences and values of the patient must be considered in the decision making.

Keywords

Carotid Endarterectomy Absolute Risk Reduc Surgical Trial Periodic Health Examination Evidence Base Medicine Working Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Evidence Based Medicine Working Group. Evidence-based medicine. JAMA 1992;268:2420–2425.CrossRefGoogle Scholar
  2. 2.
    Davidoff F, Haynnes B, Sackett D, Smith R. Evidence based medicine. A new journal to help doctors identify the information they need. BMJ 1998;310:1085–1086.Google Scholar
  3. 3.
    Wai E, Wright JG. Evidence-based surgery. 1A. The traditional practice of surgery. Curr Controversies Surg 1999;33:1–15.Google Scholar
  4. 4.
    Ruffin JM, Grizzle JE, Hightower NC, McHardy G, Shull H, Kirsner JB. A co-operative double blind evaluation of gastric “freezing” in the treatment of duodenal ulcer. N Engl J Med 1969;281:16–19.PubMedGoogle Scholar
  5. 5.
    Calandra T, Baumgartner JD, Grau EG, et al. Prognostic values of tumor necrosis factor/cachectin, interleukin-1, interferon-alpha and interferon-gamma in the serum of patients with septic shock. J Infect Dis 1990;161:982–987.PubMedGoogle Scholar
  6. 6.
    Fisher CJ, Dhaniaut JFA, Opal SM, et al. Recombinant human interleukin receptor antagonist in the treatment of patients with sepsis syndrome. JAMA 1994;271:1836–1843.PubMedCrossRefGoogle Scholar
  7. 7.
    Seward WF. Medical economics. Bull Am Coll Surg 1999;84:12–13.Google Scholar
  8. 8.
    Antman EM, Lau J, Kupelnick B, Mosteller F, Chalmers TC. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992;268:240–248.PubMedCrossRefGoogle Scholar
  9. 9.
    Kreder HJ. Evidence based surgical practice: what is it and do we need it? W J Surg in press.Google Scholar
  10. 10.
    Anderson FA Jr, Wheeler B, Goldberg RJ, Hosmer DW, Forcier A, Patawardhan NA. Physician practices in the prevention of venous thromboembolism. Ann Intern Med 1991;115:591–595.PubMedGoogle Scholar
  11. 11.
    Ellis J, Mulligan I, Rowe J, Sackett D. Inpatient general medicine is evidence based. Lancet 1995;346:407–410.PubMedCrossRefGoogle Scholar
  12. 12.
    Howes N, Chagla L, Thorpe M, McCulloch P. Surgical practice is evidence based. BJS 1997;84:1220–1223.CrossRefGoogle Scholar
  13. 13.
    Rosenberg W, Donald A. Evidence based medicine: an approach to clinical problemsolving. BMJ 1995;310:1126.Google Scholar
  14. 14.
    Canadian Task Force on Periodic Health Examination. The periodic health examination. CMAJ 1979;121:1193–1254.Google Scholar
  15. 15.
    Solomon MJ, McLeod RS. Clinical studies in surgical journals—have we improved? Dis Colon Rectum 1993;36:43–48.PubMedCrossRefGoogle Scholar
  16. 16.
    Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Eng J Med 1992;326:653–657.Google Scholar
  17. 17.
    Shapiro S. Evidence of screening for breast cancer from a randomized trial. Cancer 1977;39(suppl):2772.PubMedCrossRefGoogle Scholar
  18. 18.
    Detsky AS. Are clinical trials a cost effective investment? JAMA 1983;262:1795–1800.CrossRefGoogle Scholar
  19. 19.
    McLeod RS, Wright JG, Solomon MJ, Hu X, Walters BC, Lossing A. Randomized controlled trials in surgery; issues and problems. Surgery 1996;119:483–486.PubMedCrossRefGoogle Scholar
  20. 20.
    Dimond EG, Kittle CF, Crockett JE. Evaluation of internal mamary artery ligation and sham procedure in angina pectoris. Circulation 1958:18:712–713.Google Scholar
  21. 21.
    Chalmers TC. Randomization of the first patient. Med Clin North Am 1975;59:1035–1038.PubMedGoogle Scholar
  22. 22.
    Taylor K, Margolese R, Soskolne CL. Physicians’ reasons for not entering eligible patients in a randomized clinical trial of adjuvant surgery for breast cancer. N Engl J Med 1984;310:1363–1367.PubMedGoogle Scholar
  23. 23.
    Kennedy ED, Blair JE, Ready R, et al. Patients’ perceptions of their participation in a clinical trial for postoperative Crohn’s disease. Can J Gastroenterol 1998;12:287–291.PubMedGoogle Scholar
  24. 24.
    Fisher B, Bauer M, Margolese R, et al. Five year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665–673.PubMedGoogle Scholar
  25. 25.
    The EC/ IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med 1985;313:1191–1200.Google Scholar
  26. 26.
    Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. N Engl J Med 1992;326:786–792.PubMedGoogle Scholar
  27. 27.
    Health Services Research Group. Outcomes and the management of health care. CMAJ 1992;147:1775–1779.Google Scholar
  28. 28.
    Committee to Design a Strategy for Quality Review and Assurance in Medicare, Institute of Medicine. Medicare; a Strategy for Quality Assurance. Washington, DC: National Academy Press; 1990.Google Scholar
  29. 29.
    Greenfield S. The state of outcome research: are we on target? N Engl J Med 1989;320:1142–1143.PubMedGoogle Scholar
  30. 30.
    North American Symptomatic Carotid Endarterectomy Trial collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.Google Scholar
  31. 31.
    Kucey DS, Bowyer B, Iron K, Austin P, Anderson G, Tu JV. Determinants of outcome after carotid endarterectomy. J Vasc Surg 1998;28:1051–1058.PubMedCrossRefGoogle Scholar
  32. 32.
    Health Services Group. Small-area variations: what are they and what do they mean? CMAJ 1992;146:467–470.Google Scholar
  33. 33.
    Iscoe NA, Goel V, Wu K, Fehringer G, Holowaty EJ, Naylor CD. Variation in breast cancer surgery in Ontario. CMAJ 1994;150:245–352.Google Scholar
  34. 34.
    Eddy DM. Variations in physician practice: the role of uncertainty. Health Aff (Millwood) 1984;3:74–89.CrossRefGoogle Scholar
  35. 35.
    Wennberg JE. Dealing with medical practice variations: a proposal for action. Health Aff (Millwood) 1984;3:6–32.CrossRefGoogle Scholar
  36. 36.
    Wright JG, Hawker GA, Bombardier C, et al. Physician enthusiasm as an explanation for area variation in the utilization of knee-replacement surgery. Med Care 1999;37:946–956.PubMedCrossRefGoogle Scholar
  37. 37.
    Brook RH, Kosecoff JB, Park RE, Chassin MR, Winslow CM, Hampton JR. Diagnosis and treatment of coronary disease: comparisons of doctors’ attitudes in the USA and UK. Lancet 1988;1:750–753.PubMedCrossRefGoogle Scholar
  38. 38.
    Blais R. Variations in the use of health care services: why are more studies needed? CMAJ 1994;151:1701–1719.PubMedGoogle Scholar
  39. 39.
    Wennberg JE. Which rate is right? [editorial]. N Engl J Med 1986;314:310–311.PubMedCrossRefGoogle Scholar
  40. 40.
    Wright JG, Coyte P, Hawker G, et al. Variation in orthopedic surgeon’s perceptions of the indications for and outcomes of knee replacement. CMAJ 1995;152:687–697.PubMedGoogle Scholar
  41. 41.
    Porter GA, Soskolne CL, Yakimets WW, Newman SC. Surgeon-related factors and outcome in rectal cancer. Ann Surg 1998;227:157–167.PubMedCrossRefGoogle Scholar
  42. 42.
    Lieberman MD, Kilburn H, Lindsey M, Brennen MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645.PubMedCrossRefGoogle Scholar
  43. 43.
    Simunovic M, To T, Theriault M, Langer B. Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system. CMAJ 1999;160:643–648.PubMedGoogle Scholar
  44. 44.
    Gordon TA, Burleyson GP, Tielsch JM, Cameron JL. The effects of regionalization on cost and outcome for 1 general high-risk surgical procedure. Ann Surg 1995;221:43–49.PubMedCrossRefGoogle Scholar
  45. 45.
    Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw AL, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999;125:250–256.PubMedGoogle Scholar
  46. 46.
    Khuri SF, Henderson WG, Hur K, Hossein M, Daley J. The relationship of surgical volume to outcome in 8 common operations. Paper presented at: the meeting of the American Surgical Association; April 1999; San Diego, CA.Google Scholar
  47. 47.
    Halm EA, Lee C, Chassin MR. Is volume outcome related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511–520.PubMedGoogle Scholar
  48. 48.
    US Preventive Services Task Force. Guide to Clinical Preventive Services. An Assessment of 169 Interventions. Baltimore: Williams & Wilkins; 1989.Google Scholar
  49. 49.
    Guyatt GH, Sackett DL, Sinclair JC, Hayward R, Cook DJ, Cook RJ, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. IX. A method for grading health care recommendations. JAMA 1995;274:1800–1804.PubMedCrossRefGoogle Scholar
  50. 50.
    Liberati A. Problems in defining hierarchies (levels) of evidence for studies to be included in systematic reviews of effectiveness of interventions. Paper presented at: the Second Symposium on Systematic Reviews: Beyond the Basics; January 1999; Oxford.Google Scholar
  51. 51.
    Levels of evidence and grade recommendation. Available at: http:www.cebm.net/levels_of_evidence.asp.Google Scholar
  52. 52.
    Horton R. Surgical research or comic opera: questions, but few answers. Lancet 1996;347:984–985.PubMedCrossRefGoogle Scholar
  53. 53.
    Spodick DH. Randomized controlled clinical trials. The behavioral case. JAMA 1982;247:2258–2260.PubMedCrossRefGoogle Scholar
  54. 54.
    Barnes RW. Understanding investigative clinical trials. J Vasc Surg 1989;9:609–618.PubMedGoogle Scholar
  55. 55.
    Haines SJ. Randomized clinical trials in the evaluation of surgical innovation. Neurosurgery 1979;51:5–11.CrossRefGoogle Scholar
  56. 56.
    Solomon MJ, Laxamana A, Devore L, McLeod RS. Randomized controlled trials in surgery. Surgery 1994;115:707–712.PubMedGoogle Scholar
  57. 57.
    Hall JC, Mills B, Nguyen H, Hall JL. Methodological standards in clinical trials. Surgery 1996;119:466–472.PubMedCrossRefGoogle Scholar
  58. 58.
    Solomon JS, McLeod RS. Should we be performing more randomized controlled trials evaluating surgical operations? Surgery 1995;118:459–467.PubMedCrossRefGoogle Scholar
  59. 59.
    Goligher JC, Pulvertaft CN, Watkinson G. Controlled trial of vagotomy and gastroenterology, vagotomy and gastroenterostomy, vagotomy and antrectomy and subtotal gastrectomy in elective treatment of duodenal ulcer. BMJ 1964;1455–1460.Google Scholar
  60. 60.
    Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam consultation on meta-analysis. J Clin Epidemiol 1995;48:167–171.PubMedCrossRefGoogle Scholar
  61. 61.
    L’Abbee KA, Detsky AS, O’Rourke K. Meta-analysis in clinical research. Ann Intern Med 1987;107:224–233.Google Scholar
  62. 62.
    Spitzer WO, ed. The Potsdam International Consultation on Meta-analysis. J Clin Epidemiol 1995;48:1–171.Google Scholar
  63. 63.
    Chalmers TC, Altman DG, eds. Systematic Reviews. London: British Medical Journal Publishing Group; 1995.Google Scholar
  64. 64.
    Oxman AD, Cook DJ, Guyatt GH. Users’ guides to the medical literature. VI. How to use an overview. Evidence-Based Medicine Working Group. JAMA 1994;272:1367–1371.PubMedCrossRefGoogle Scholar
  65. 65.
    Moher D, Olkin I. Meta-analysis of randomized controlled trials: a concern for standards. JAMA 1995;274:1962–1964.PubMedCrossRefGoogle Scholar
  66. 66.
    LeLorier J, Gregoire G, Benhaddad A, Lapierre J, Dederian F. Discrepancies between meta-analysis and subsequent large randomized, controlled trials. N Engl J Med 1997;337:536–542.PubMedCrossRefGoogle Scholar
  67. 67.
    Moher D, Olkin I. Meta-analysis of randomized controlled trials: a concern for standards. JAMA 1995;274:1962–1964.PubMedCrossRefGoogle Scholar
  68. 68.
    Dickerson K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ 1994;309:1286–1291.Google Scholar
  69. 69.
    Moher D, Fortin P, Jadad AR, et al. Completeness of reporting of trials published in languages other than English: implications for conduct and reporting of systematic reviews. Lancet 1996;347:363–366.PubMedCrossRefGoogle Scholar
  70. 70.
    Jadad AR, McQuay HJ. Meta-analyses to evaluate analgesic interventions: a systematic qualitative review of their methodology. J Clin Epidemiol 1996;49:235–243.PubMedCrossRefGoogle Scholar
  71. 71.
    Dixon E, Hameed M, Sutherland F, Cook DJ, Doig C. Evaluating meta-analyses in the general surgical literature. A critical appraisal. Ann Surg 2005;241:450–459.PubMedCrossRefGoogle Scholar
  72. 72.
    Cochrane Collaboration. Cochrane Library. Vista, CA: Cochrane Collaboration. (The Cochrane Library is available on CD-ROM on a quarterly basis. The Cochrane Library, Update Software Inc., 936 La Rueda, Vista, CA 92084, USA.)Google Scholar
  73. 73.
    Committee to Advise Public Health Service on Clinical Practice Guidelines (Institute of Medicine) Clinical Practice Guidelines. Directions for a New Program. Washington, DC: National Academy Press; 1990:58.Google Scholar
  74. 74.
    Wright JG, McLeod RS, Mahoney J, Lossing A, Hu X from the Surgical Clinical Epidemiology Group. Surgery 1996;119:706–709.PubMedCrossRefGoogle Scholar
  75. 75.
    Browman GP, Levine MN, Mohide A, et al. The practice guidelines development cycle: a conceptual tool for practice guidelines development and implementation. J Clin Oncol 1995;13:502–512.PubMedGoogle Scholar
  76. 76.
    Wolff SH. Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. Arch Intern Med 1992;152:946–952.CrossRefGoogle Scholar
  77. 77.
    Hayward RSA, Wilson MC, Tunis SR, Bass EB, Guyatt GH, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. VIII. How to use clinical practice guidelines. Are recommendations valid? JAMA 1995;274:570–574.CrossRefGoogle Scholar
  78. 78.
    Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence Based Medicine. How to Practice and Teach EBM. Pearson Professional Ltd; 1997.Google Scholar
  79. 79.
    Oxman AD, Sackett DL, Guyatt GH, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. I. How to get started. JAMA 1993;270:2093–2095.PubMedCrossRefGoogle Scholar
  80. 80.
    Guyatt GH, Sackett DL, Cook DJ. Users7 guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? Evidence-Based Medicine Working Group. JAMA 1993;270:2598–2601.PubMedCrossRefGoogle Scholar
  81. 81.
    Guyatt GH, Sackett DL, Cook DJ. Users’ guides to the medical literature. II. How to use an article about therapy or prevention. B. What were the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group. patients? Evidence-Based Medicine Working Group. JAMA 1994;271:59–63.PubMedCrossRefGoogle Scholar
  82. 82.
    Jaeschke R, Guyatt GH, Sackett DL, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. HI. How to use an article about a diagnostic test. A. Are the results of the study valid? JAMA 1994;271:389–391.PubMedCrossRefGoogle Scholar
  83. 83.
    Jaeschke R, Guyatt GH, Sackett DL, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. IE. How to use an article about a diagnostic test. B. What are the results and will they help me in caring for my patients? JAMA 1994;271:703–707.PubMedCrossRefGoogle Scholar
  84. 84.
    Levine M, Walter S, Lee H, Haines T, Holbrook A, Moyer V, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. IV. How to use an article about harm. JAMA 1994;271:1615–1619.PubMedCrossRefGoogle Scholar
  85. 85.
    Laupacis A, Wells G, Richardson WS, Tugwell P, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. V. How to use an article about prognosis. JAMA 1994;272:234–237.PubMedCrossRefGoogle Scholar
  86. 86.
    Richardson WS, Detsky AS, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. VII. How to use a clinical decision analysis. A. Are the results of the study valid? JAMA 1995;273:1292–1295.PubMedCrossRefGoogle Scholar
  87. 87.
    Richardson WS, Detsky AS, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. VII. How to use a clinical decision analysis. B. What are the results and will they help me in caring for my patients? JAMA 1995’273:1610–1613.PubMedCrossRefGoogle Scholar
  88. 88.
    Naylor DC, Guyatt GH, for the evidence Based Medicine Working Group. Users7 guides to the medical literature. X. How to use an article reporting variations in the outcomes of health services. JAMA 1996;275:554–558.PubMedCrossRefGoogle Scholar
  89. 89.
    Naylor CD, Guyatt GH, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. XI. How to use an article about a clinical utilization review. JAMA 1996;275:1435–1439.PubMedCrossRefGoogle Scholar
  90. 90.
    Guyatt GH, Naylor CD, Juniper E, Heyland DK, Jaeschke R, Cook DJ, for the Evidence Based Medicine Working Group. Users7 guides to the medical literature. XII. How to use an article about health-related quality of life. JAMA 1997;277:1232–1237.PubMedCrossRefGoogle Scholar
  91. 91.
    Drummond MF, Richardson WS, O’Brien BJ, Levine M, Heyland D, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. XIII. How to use an article on economic analysis of clinical practice. A. Are the results of the study valid? JAMA 1997;277:1552–1557.PubMedCrossRefGoogle Scholar
  92. 92.
    O’Brien BJ, Heyland D, Richardson WS, Levine M, Drummond MF, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. XIII. How to use an article on economic analysis of clinical practice. B. What are the results and will they help me in caring for my patients? JAMA 1997;277:1802–1806.PubMedCrossRefGoogle Scholar
  93. 93.
    Dans AL, Dans LF, Guyatt GH, Richardson S, for the Evidence Based Medicine Working Group. Users’ guides to the medical literature. XTV. How to decide on the applicability of clinical trial results to your patient. JAMA 1998;279:545–549.PubMedCrossRefGoogle Scholar
  94. 94.
    Last JM. A Dictionary of Epidemiology. Oxford Medical Publications; 1983.Google Scholar
  95. 95.
    Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452–454.PubMedGoogle Scholar
  96. 96.
    Guyatt GH, Jaeschke R, Heddle N, Cook D, Shannon H, Walter S. Basic statistics for clinicians: 2. Interpreting study results: confidence intervals. CMAJ 1995;152:169–173.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Robin S. McLeod
    • 1
    • 2
  1. 1.Department of SurgeryUniversity of TorontoToronto
  2. 2.Division of General SurgeryMount Sinai HospitalTorontoCanada

Personalised recommendations