Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
Br J Anaesth. 2021 Dec;127(6):905-916. doi: 10.1016/j.bja.2021.08.016. Epub 2021 Sep 20.
Cardiac assessment in noncardiac surgery clinical practice guidelines should be supported by the highest-quality evidence such as that offered by systematic reviews. Currently, the methodological and reporting quality of these studies remains unknown.
We used PubMed to search for all clinical practice guidelines related to perioperative cardiovascular patients undergoing noncardiac surgery from 2010 to 2021. The included clinical practice guidelines were analysed for all systematic reviews and meta-analyses. The primary objective of this study was to determine reporting and methodological quality using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) instruments. Our secondary objective was to compare systematic reviews conducted by the Cochrane Collaboration with non-Cochrane studies.
Three clinical practice guidelines were included in our study. Within these, 78 systematic reviews were included. PRISMA completion ranged from 34.8% to 100.0% with a mean of 76.9%. AMSTAR-2 completion ranged from 15.6% to 96.9% with a mean of 58.0%. Fifty-four systematic reviews underpinned a clinical practice guidelines recommendation, of which 25 were rated 'critically low' by AMSTAR-2 appraisal. Cochrane systematic reviews typically performed better than non-Cochrane studies, but were a minority of the included studies (10/78).
We found deficiencies in several key areas regarding the methodological and reporting qualities of systematic reviews included in cardiac assessment in noncardiac surgery clinical practice guidelines. As these clinical practice guidelines are instrumental to clinical decision-making and patient care in cardiac assessment in noncardiac surgery, we advocate for improved reporting quality among systematic reviews cited as supportive evidence for these recommendations.
非心脏手术临床实践指南中的心脏评估应得到系统评价等最高质量证据的支持。目前，这些研究的方法学和报告质量尚不清楚。
我们使用 PubMed 搜索了 2010 年至 2021 年期间与围手术期心血管患者接受非心脏手术相关的所有临床实践指南。对纳入的临床实践指南进行了所有系统评价和荟萃分析的分析。本研究的主要目的是使用 PRISMA（系统评价和荟萃分析的首选报告工具）和 AMSTAR-2（系统评价测量工具-2）工具来确定报告和方法学质量。我们的次要目标是比较 Cochrane 协作组进行的系统评价与非 Cochrane 研究。
我们的研究纳入了 3 项临床实践指南，其中纳入了 78 项系统评价。PRISMA 完成率从 34.8%到 100.0%不等，平均为 76.9%。AMSTAR-2 完成率从 15.6%到 96.9%不等，平均为 58.0%。78 项系统评价中有 54 项为临床实践指南推荐提供了依据，其中 25 项经 AMSTAR-2 评估被评为“极低”。Cochrane 系统评价的表现通常优于非 Cochrane 研究，但在纳入的研究中占少数（10/78）。
我们发现纳入非心脏手术临床实践指南中心脏评估的系统评价在方法学和报告质量方面存在几个关键领域的缺陷。由于这些临床实践指南对非心脏手术中心脏评估的临床决策和患者护理至关重要，我们主张提高作为这些建议支持证据的系统评价的报告质量。
