Meta-analysis in surgery: methods and limitations.

The growth of new knowledge continues to advance the surgical disciplines, and several types of literature reviews attempt to consolidate this expansion of information. Meta-analysis is one such method that integrates findings on the same subject from different studies. Within surgery, there is a wealth of literature on a given topic, which needs to be considered collectively. As such, meta-analyses have been performed to address issues like the use of bowel preparation for colorectal surgery and comparisons of outcomes for laparoscopic vs open surgical approaches. A basic understanding of the groundwork required for meta-analysis is fundamental toward interpreting and critiquing its results. This review provides an overview of the principles, application, and limitations of meta-analysis in the context of surgery.

[1]  W. Richardson,et al.  Selecting and Appraising Studies for a Systematic Review , 1997, Annals of Internal Medicine.

[2]  G. Smith,et al.  Meta-analysis: Unresolved issues and future developments , 1998, BMJ.

[3]  J. Bailar The promise and problems of meta-analysis. , 1997, The New England journal of medicine.

[4]  P. Shekelle,et al.  Meta-Analysis: Surgical Treatment of Obesity , 2005, Annals of Internal Medicine.

[5]  Mike Clarke,et al.  EFFECTS OF RADIOTHERAPY AND SURGERY IN EARLY BREAST-CANCER - AN OVERVIEW OF THE RANDOMIZED TRIALS , 1995 .

[6]  Stefan Sauerland,et al.  Role of Systematic Reviews and Meta-analysis in Evidence-based Medicine , 2005, World Journal of Surgery.

[7]  L. Stewart,et al.  Practical methodology of meta-analyses (overviews) using updated individual patient data. Cochrane Working Group. , 1995, Statistics in medicine.

[8]  G. Glass Primary, Secondary, and Meta-Analysis of Research , 2008 .

[9]  Anthony Howell,et al.  Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. , 1995, The New England journal of medicine.

[10]  L. Simpson Report on Certain Enteric Fever Inoculation Statistics , 1904, British medical journal.

[11]  G. Smith,et al.  Meta-analysis: Potentials and promise , 1997, BMJ.

[12]  A. L. Cochrane,et al.  Effectiveness and efficiency: random reflections on health services , 1972 .

[13]  D. Chang,et al.  Meta-analysis of the clinical outcome of carbapenem monotherapy in the adjunctive treatment of intra-abdominal infections. , 1997, American journal of surgery.

[14]  C. Counsell,et al.  Formulating Questions and Locating Primary Studies for Inclusion in Systematic Reviews , 1997, Annals of Internal Medicine.

[15]  M. Egger,et al.  Bias in location and selection of studies. , 1998, BMJ.

[16]  F. Mosteller,et al.  A study of the placebo response. , 1954, The American journal of medicine.

[17]  S. Sauerland,et al.  Laparoscopic versus open surgery for suspected appendicitis. , 2002, The Cochrane database of systematic reviews.

[18]  Ronin,et al.  Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. , 1995, The New England journal of medicine.

[19]  G. Grégoire,et al.  Discrepancies between meta-analyses and subsequent large randomized, controlled trials. , 1997, The New England journal of medicine.

[20]  George Davey Smith,et al.  meta-analysis bias in location and selection of studies , 1998 .

[21]  B. Efron,et al.  Stein's Paradox in Statistics , 1977 .

[22]  A. Grant Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data , 2002, Hernia.

[23]  J C Bailar,et al.  The practice of meta-analysis. , 1995, Journal of clinical epidemiology.

[24]  George Davey Smith,et al.  Meta-analysis: Principles and procedures , 1997, BMJ.

[25]  D. Cook,et al.  Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? , 1998, The Lancet.

[26]  Henry Buchwald,et al.  Bariatric surgery: a systematic review and meta-analysis. , 2004, JAMA.

[27]  D. Cook,et al.  Evaluating Meta-analyses in the General Surgical Literature: A Critical Appraisal , 2005, Annals of surgery.