Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

Savović, Jelena; Blencowe, Natalie S; Strong, Sean; Howes, Noah; Chalmers, Katy A; Chrichton, J U; Gould, Laura; Kariyawasam, Sanjeeva; Mason, John; Pegna, Victoria; Richards, Sarah; Rowlands, Ceri; Stevens, Daniel J.; Whale, Katie; Blazeby, Jane M

doi:10.1002/bjs.10476

Cited by 9 publications

(2 citation statements)

References 145 publications

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“…High or unclear risk of bias within reviews have affected the conclusions drawn from this evidence synthesis. In a systematic review of 106 emergency surgery systematic reviews, a low risk of bias was found in 53.8%, identifying a common problem of poor quality reviews conducted in emergency surgery 50…”

Section: Discussionmentioning

confidence: 99%

Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults

et al. 2019

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ObjectivesMultiple systematic reviews have reported on the impact of rib fracture fixation in the presence of flail chest and multiple rib fractures, however this practice remains controversial. Our aim is to synthesise the effectiveness of surgical rib fracture fixation as evidenced by systematic reviews.DesignA systematic search identified systematic reviews comparing effectiveness of rib fracture fixation with non-operative management of adults with flail chest or unifocal non-flail rib fractures. MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Science Citation Index were last searched 17 March 2017. Risk of bias was assessed using the Risk Of Bias In Systematic reviews (ROBIS) tool. The primary outcome was duration of mechanical ventilation.ResultsTwelve systematic reviews were included, consisting of 3 unique randomised controlled trials and 19 non-randomised studies. Length of mechanical ventilation was shorter in the fixation group compared with the non–operative group in flail chest; pooled estimates ranged from −4.52 days, 95% CI (−5.54 to –3.5) to −7.5 days, 95% CI (−9.9 to –5.5). Pneumonia, length of hospital and intensive care unit stay all showed a statistically significant improvement in favour of fixation for flail chest; however, all outcomes in favour of fixation had substantial heterogeneity. There was no statistically significant difference between groups in mortality. Two systematic reviews included one non-randomised studies of unifocal non-flail rib fracture population; due to limited evidence the benefits with surgery are uncertain.ConclusionsSynthesis of the reviews has shown some potential improvement in patient outcomes with flail chest after fixation. For future review updates, meta-analysis for effectiveness may need to take into account indications and timing of surgery as a subgroup analysis to address clinical heterogeneity between primary studies. Further robust evidence is required before conclusions can be drawn of the effectiveness of surgical fixation for flail chest and in particular, unifocal non-flail rib fractures.PROSPERO registration numberCRD42016053494.

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Section: Discussionmentioning

confidence: 99%

Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults

et al. 2019

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“…The quality of randomised data and outcomes reporting in ASBO is limited [ 7 , 8 , 9 ]. The most recent trials in ASBO focus on the use of water soluble contrast agents [ 10 ], or laparoscopic surgery [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A core outcome set for clinical studies of adhesive small bowel obstruction

Lee¹,

Chapman²,

Blackwell³

et al. 2022

Colorectal Disease

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Aim: Adhesive small bowel obstruction (ASBO) is a common surgical emergency condition. Research in the field is plentiful; however, inconsistency in outcome reporting makes comparisons challenging. The aim of this study was to define a core outcome set (COS) for studies of ASBO. Methods:The long list of outcomes was identified through systematic review, and focus groups across different geographical regions. A modified Delphi consensus exercise of three rounds was undertaken with stakeholder groups (patients and clinicians). Items were rated on a 9-point Likert scale. Items exceeding 70% rating at 7-9 were passed to the consensus meeting. New item proposals were invited in round 1. Individualised feedback on prior voting compared to other participants was provided. An international consensus meeting was convened to ratify the final COS. Results:In round 1, 56 items were rated by 118 respondents. A total of 18 items reached consensus, and respondents proposed an additional 10 items. Round 2 was completed by 90 respondents, and nine items achieved consensus. In round 3, 80 surveys were completed; one item achieved consensus, and five borderline items were identified. The final COS included 26 outcomes, mapped to the following domains: Interventions, need for stoma, septic complications, return of gut function, patient reported outcomes, and recurrence of obstruction, as well as mortality, failure to rescue, and time to resolution. Conclusion:This COS should be used in future studies in the treatment of adhesive SBO. Further studies to define a core measurement set are needed to identify the optimum tools to measure each outcome.

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Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review

Lee

Coe

O'Donoghue³

et al. 2020

British Journal of Surgery

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Background: The ability to compare findings across surgical research is important. Inadequate description of participants, interventions or outcomes could lead to bias and inaccurate assessment of findings. The aim of this study was to assess consistency of description of participants using studies comparing laparoscopic and open repair of peptic ulcer as an example. Methods: This systematic review is reported in line with the PRISMA checklist. Searches of MEDLINE and Embase databases were performed to identify studies comparing laparoscopic and open repair of perforated peptic ulcer in adults, published in the English language. Manuscripts were dual-screened for eligibility. Full texts were retrieved and dual-screened for inclusion. Data extracted from studies included descriptors of participants in studies from tables and text. Descriptors were categorized into conceptual domains by the research team, and coverage of each domain by study was tabulated. Results: Searches identified 2018 studies. After screening, 37 full texts were retrieved and 23 studies were included in the final synthesis. A total of 76 unique descriptors were identified. These were classified into demographics (11 descriptors), vital signs (9 descriptors), disease-specific characteristics (10 descriptors), presentation and pathway factors (4 descriptors), risk factors (8 descriptors), laboratory tests (14 descriptors) and baseline health (28 descriptors). The number of descriptors in a single study ranged from three to 31. All studies reported at least one demographic descriptor. Laboratory tests was the least frequently described domain. Conclusion: Study participants are described inconsistently in studies of a single example surgical condition.

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Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

Cited by 9 publications

References 145 publications

Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults

Systematic review of systematic reviews for effectiveness of internal fixation for flail chest and rib fractures in adults

A core outcome set for clinical studies of adhesive small bowel obstruction

Variation in descriptors of patient characteristics in randomized clinical trials of peptic ulcer repair: a systematic review

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