Perspectives of Evidence-Based Surgery

The assessment of the optimal treatment option based on best current knowledge is called evidence-based medicine (EBM). Considering the cost explosion in public health systems, EBM should also incorporate proper utilization of the restricted economical resources and should enforce quality assurance in medicine. It is imperative that surgeons realize that randomized controlled trials are applicable to the operative specialties in a large scale, and are necessary to provide evidence-based surgery. So far, only 3.4% of all publications in the leading surgical journals are randomized controlled trials. Furthermore, only 44.1% of the published surgical randomized controlled studies compared different surgical procedures, whereas 55.9% of the articles compared medical therapies in surgical patients. Evidence-based surgical therapy is essential for further development of a high- quality surgical standard, which will also provide quality assurance in future surgical care. This article presents the definition of EBM and discusses specific problems involved in the introduction of its principles into the surgical discipline.

[1]  L. Cobb,et al.  An evaluation of internal-mammary-artery ligation by a double-blind technic. , 1959, The New England journal of medicine.

[2]  E. Dimond,et al.  Comparison of internal mammary artery ligation and sham operation for angina pectoris. , 1960, The American journal of cardiology.

[3]  C. N. Pulvertaft,et al.  Controlled Trial of Vagotomy and Gastro-enterostomy, Vagotomy and Antrectomy, and Subtotal Gastrectomy in Elective Treatment of Duodenal Ulcer: Interim Report* , 1964, British medical journal.

[4]  D. Sackett,et al.  Cochrane Collaboration , 1994, BMJ.

[5]  A. G. Johnson,et al.  Surgery as a placebo , 1994, The Lancet.

[6]  D. Sackett,et al.  Inpatient general medicine is evidence based , 1995, The Lancet.

[7]  D. Sackett,et al.  On the need for evidence-based medicine. , 1995, Journal of public health medicine.

[8]  I. Olkin,et al.  Improving the quality of reporting of randomized controlled trials. The CONSORT statement. , 1996, JAMA.

[9]  R. McLeod,et al.  Randomized controlled trials in surgery: Issues and problems. , 1996, Surgery.

[10]  Douglas G Altman,et al.  Better reporting of randomised controlled trials: the CONSORT statement , 1996, BMJ.

[11]  Richard Horton,et al.  Surgical research or comic opera: questions, but few answers , 1996, The Lancet.

[12]  C. Stoddard,et al.  Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy , 1996, The Lancet.

[13]  L. Bonchek.  Randomised trials of new procedures: problems and pitfalls , 1997, Heart.

[14]  J. Dixon,et al.  Removing bias in surgical trials , 1997, BMJ.

[15]  T. van Vroonhoven,et al.  CONSORT, randomized trials and the surgical scientific community , 1997, The British journal of surgery.

[16]  R. Newcombe,et al.  Reporting of clinical trials in Gut: the CONSORT statement. Consolidated Standards of Reporting Trials. , 1997, Gut.

[17]  D Moher,et al.  CONSORT: an evolving tool to help improve the quality of reports of randomized controlled trials. Consolidated Standards of Reporting Trials. , 1998, JAMA.

[18]  Surgery and evidence‐based medicine , 1998, The Medical journal of Australia.

[19]  J. R. Thomas.  PLACEBO SURGERY , 1960, Missouri medicine.

[20]  T. Hugh.  Surgery and the randomised controlled trial: past, present and future , 1999, The Medical journal of Australia.

[21]  S. Sauerland,et al.  The pros and cons of evidence-based surgery , 1999, Langenbeck's Archives of Surgery.

[22]  C. Olanow,et al.  Use of placebo surgery in controlled trials of a cellular-based therapy for Parkinson's disease. , 1999, The New England journal of medicine.

[23]  R. Macklin,et al.  The ethical problems with sham surgery in clinical research. , 1999, The New England journal of medicine.

[24]  C Bain,et al.  Interpreting the evidence: choosing between randomised and non-randomised studies , 1999, BMJ.

[25]  W. Uhl,et al.  Chirurgisch-klinische Studien in der praktischen Durchführung , 2000, Der Chirurg.

[26]  What is so important about systematic reviews , 2000, Acta psychiatrica Scandinavica.

[27]  J. Urschel,et al.  Is general thoracic surgical practice evidence based? , 2000, The Annals of thoracic surgery.

[28]  [Surgical clinical studies and their practical realization]. , 2000, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[29]  D. Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials , 2001, The Lancet.

[30]  D Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. , 2001, Journal of the American Podiatric Medical Association.

[31]  D. Moher,et al.  Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. , 2001, JAMA.

[32]  D Moher,et al.  The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. , 2001, Annals of internal medicine.

[33]  Mitsuru Sasako,et al.  Randomised trials in surgery: problems and possible solutions , 2002, BMJ : British Medical Journal.

[34]  S. Seiden,et al.  Surgical “Placebo” Controls , 2002, Annals of surgery.

[35]  G. Steineck.  [Is placebo surgery unethical?]. , 2002, Lakartidningen.

[36]  K. O'malley,et al.  A controlled trial of arthroscopic surgery for osteoarthritis of the knee. , 2002, The New England journal of medicine.

[37]  N Engl,et al.  A controlled trial of arthroscopic surgery for osteoarthritis of the knee , 2005 .