Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Eur Surg Res. 2021;62(4):221-228. doi: 10.1159/000519593. Epub 2021 Oct 28.
Systematic reviews and meta-analyses are generally regarded as sitting atop the hierarchy of clinical evidence. The unbiased summary of current evidence that a systematic review provides, along with the increased statistical power from larger numbers of patients, is invaluable in guiding clinical decision-making and development of practice guidelines. Surgical specialties have historically lagged behind other areas of medicine in the application of evidence-based medicine, perhaps due to the unique challenges faced in the conduct of surgical clinical trials. These challenges extend to the conduct of systematic reviews, due to issues with the quality and heterogeneity of the underlying literature.
Recent years have seen an improvement in the quality of randomized controlled trials in surgical topics and an explosion in the publication of systematic reviews. This review explores recent trends in systematic reviews in surgery and discussed some of the aspects in conducting and interpreting reviews that are unique to surgical topics, including blinding, surgical heterogeneity and learning curves, patient and clinician preference, and industry involvement. Key Messages: Clinical trials, and therefore systematic reviews, of surgical interventions pose unique challenges which are important to consider when conducting them or applying the findings to clinical practice. Despite the challenges, systematic reviews still represent the best level of evidence for development of surgical practice guidelines.
系统评价和荟萃分析通常被认为处于临床证据的层级之首。系统评价提供的当前证据的无偏总结，以及更大数量患者带来的统计学效力增加，对于指导临床决策和实践指南的制定是非常宝贵的。由于在进行外科临床试验时面临的独特挑战，外科专业在循证医学的应用方面一直落后于医学的其他领域。这些挑战也延伸到了系统评价的开展，因为基础文献的质量和异质性存在问题。
近年来，外科领域随机对照试验的质量有所提高，系统评价的发表也呈爆炸式增长。这篇综述探讨了外科领域系统评价的最新趋势，并讨论了一些在进行和解释外科专题系统评价时独特的方面，包括盲法、外科异质性和学习曲线、患者和临床医生偏好以及行业参与。要点：外科干预的临床试验，因此也包括系统评价，提出了一些独特的挑战，在进行这些研究或将研究结果应用于临床实践时，这些挑战非常重要。尽管存在挑战，但系统评价仍然是制定外科实践指南的最佳证据级别。
