Inflammatory bowel disease meta‐evidence and its challenges: is it time to restructure surgical research?

Delaney, John; Laws, P.; Wille‐Jørgensen, Peer; Engel, Alexander

doi:10.1111/codi.12882

Cited by 6 publications

(5 citation statements)

References 170 publications

(181 reference statements)

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“…Previous studies have found that surgical meta-evidence is more likely to have poorer methodology, 12 though this paper did not find support for that claim (potentially demonstrating an improving methodology in surgical meta-evidence, a topic for further research). Despite parity on this and other metrics, our study has found that combined surgical evidence is more than twice as likely to be equivocal when compared with corresponding medical reviews.…”

Section: Discussioncontrasting

confidence: 84%

“…The results of those studies suggest that, in general, meta-evidence within surgery is of poorer methodological quality. 12–14 We therefore have a situation where, despite best efforts, surgical meta-evidence is being created from studies of poorer methodological quality than their medical counterparts, and the systematic reviews and meta-analyses themselves are performed with less rigour.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of equivocation in surgical meta-evidence: a review of systematic reviews within IBD literature

et al. 2017

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ObjectiveTo assess the level of equivocation among level 1 evidence in ulcerative colitis and Crohn’s disease and determine whether any predisposing factors are present.MethodMEDLINE, Embase, CINHAL and Cochrane were searched from 2006 to 2017. Papers were scored using AMSTAR and categorised into surgical (S), medical (M) or medical and surgical (MS) groups. The ability of each paper to make a recommendation and conclusiveness in doing so was recorded.Results278 papers were assessed. 82% (n=227) could make a recommendation, 18% (n=51) could not. There was a significant difference in ability to provide a recommendation between S and M (P=0.003) but not MS and M (P=0.022) nor S and MS (P=0.79). Where a recommendation was made, S papers were more likely to be tempered than M papers (P=0.014) but not MS papers (P=0.987).ConclusionsSurgical meta-evidence within the inflammatory bowel disease domain is more than twice as likely as medical meta-evidence to be unable to provide a recommendation for clinical practice. Where a recommendation was made, surgical reviews were twice as likely to temper their conclusion.

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Section: Discussioncontrasting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Frequency of equivocation in surgical meta-evidence: a review of systematic reviews within IBD literature

et al. 2017

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“…Similar to our findings, the quality of SRs has been found to be low to moderate in fields such as orthopedics, 22 urology, 23 pulmonology, 24,25 gastroenterology, 26 neurology, 27 psychiatry, 10 gynecology, 28 and orthodontics. 29 Common deficits that led to lower quality scores were the lack of assessment of publication bias, lack of declaration of conflicts of interest, and lack of providing an a priori protocol.…”

Section: Main Findingssupporting

confidence: 90%

Interventional Radiology Clinical Practice Guideline Recommendations for Neurovascular Disorders Are Not Based on High-Quality Systematic Reviews

Chong

Taylor

Schubert

et al. 2017

AJNR Am J Neuroradiol

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The methodologic quality of systematic reviews needs to be improved. Although reporting clarity was much better than the methodologic quality, it still has room for improvement. The methodologic quality and transparency of reporting did not vary much among clinical practice guidelines. This study can also be applied to other medical specialties to examine the quality of studies used as evidence in their own clinical practice guidelines.

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“…All of this has led to a decrease in the quality of the meta-analysis results which try to evaluate the long-term impact of surgical interventions / reinterventions in CD. One of the causes of this variability / heterogeneity in outcomes is due to the small number of patients enrolled in these retrospective studies, and to the multiple causes that influence the postoperative outcome (33). So inclusion of a representative sample in a randomized trial of CD would probably require a very long trial.…”

Section: Discussionmentioning

confidence: 99%

Reintervention Rate Following Emergency Surgery for Crohn Disease

Slavu¹,

Aleçu²,

Tulin³

et al. 2018

chr

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Backround/Objective: To assess the impact of emergency surgery and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course while observing different factors that may influence it. Information on 37 consecutive patients which were diagnosed and operated in emergency for CD complications and the the relapse rate (regarded as a second surgery) were retrospectively evaluated. The risk of relapse and second surgery was increased in males under 50 years and in those who benefited from an anastomosis during the first invervention while stomy seemed to reduce the rate of surgical relapse. The median duration until relapse was 2,3 years while a percentage of 33% required reintervention. The majority of patients with CD will undergo at least one surgical intervention during their lifetime and one third of them will relapse requiring a second intervention. Although medical treatment has seen great advancements, surgery requirements have remained unchanged as the mainstay treatment in emergent complications of CD. The age of the patients, smoking status and the postoperative medication influence the rate of postoperative recurrence.

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Inflammatory bowel disease meta‐evidence and its challenges: is it time to restructure surgical research?

Cited by 6 publications

References 170 publications

Frequency of equivocation in surgical meta-evidence: a review of systematic reviews within IBD literature

Frequency of equivocation in surgical meta-evidence: a review of systematic reviews within IBD literature

Interventional Radiology Clinical Practice Guideline Recommendations for Neurovascular Disorders Are Not Based on High-Quality Systematic Reviews

Reintervention Rate Following Emergency Surgery for Crohn Disease

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