Department of Surgery and Cancer, Imperial College London, Queen Elizabeth The Queen Mother (QEQM) Building, St. Mary's Hospital Campus, London, W2 1NY, UK.
World J Surg. 2012 Aug;36(8):1723-31. doi: 10.1007/s00268-012-1597-x.
Surgery is a rapidly evolving field, making the rigorous testing of emerging innovations vital. However, most surgical research fails to employ randomized controlled trials (RCTs) and has particularly been based on low-quality study designs. Subsequently, the analysis of data through meta-analysis and evidence synthesis is particularly difficult.
Through a systematic review of the literature, this article explores the barriers to achieving a strong evidence base in surgery and offers potential solutions to overcome the barriers.
Many barriers exist to evidence-based surgical research. They include enabling factors, such as funding, time, infrastructure, patient preference, ethical issues, and additionally barriers associated with specific attributes related to researchers, methodologies, or interventions. Novel evidence synthesis techniques in surgery are discussed, including graphics synthesis, treatment networks, and network meta-analyses that help overcome many of the limitations associated with existing techniques. They offer the opportunity to assess gaps and quantitatively present inconsistencies within the existing evidence of RCTs.
Poorly or inadequately performed RCTs and meta-analyses can give rise to incorrect results and thus fail to inform clinical practice or revise policy. The above barriers can be overcome by providing academic leadership and good organizational support to ensure that adequate personnel, resources, and funding are allocated to the researcher. Training in research methodology and data interpretation can ensure that trials are conducted correctly and evidence is adequately synthesized and disseminated. The ultimate goal of overcoming the barriers to evidence-based surgery includes the improved quality of patient care in addition to enhanced patient outcomes.
外科手术是一个快速发展的领域，因此严格测试新兴创新技术至关重要。然而，大多数外科研究未能采用随机对照试验（RCT），并且特别基于低质量的研究设计。因此，通过荟萃分析和证据综合来分析数据特别困难。
本文通过对文献的系统回顾，探讨了在外科领域中实现强有力证据基础的障碍，并提出了克服这些障碍的潜在解决方案。
外科循证研究存在许多障碍。它们包括促进因素，如资金、时间、基础设施、患者偏好、伦理问题，以及与研究人员、方法或干预措施相关的特定属性相关的障碍。本文讨论了外科中新颖的证据综合技术，包括图形综合、治疗网络和网络荟萃分析，这些技术有助于克服现有技术的许多局限性。它们提供了评估 RCT 现有证据中的差距并定量呈现不一致性的机会。
质量差或不充分的 RCT 和荟萃分析可能会导致错误的结果，从而无法为临床实践提供信息或修改政策。通过提供学术领导力和良好的组织支持，可以克服上述障碍，以确保为研究人员分配足够的人员、资源和资金。研究方法和数据解释的培训可以确保试验正确进行，并充分综合和传播证据。克服外科循证障碍的最终目标除了提高患者护理质量外，还包括改善患者结局。
