Evidence-based surgery
Surgical practice has been considered an art:
ask 50 surgeons how to manage a patient and you will probably get 50 different
answers. There is so much clinical information available that no surgeon can
know it all. Evidence-based surgery is a move to find the best ways of managing
patients using clinical evidence from collected studies. It was estimated that
sufficient evidence to justify routine myocardial thrombolysis for heart attacks
was available years before the ISIS studies which finally made it clinically
acceptable. No one had gathered all the available information together.
Centres such as the Cochrane Collaboration have been collecting randomised
trials and reviews to provide up-to-date information for clinicians. The
Cochrane Library presently includes a database of systematic reviews, reviews
of surgical effectiveness and a register of controlled trials. It is expected
that this will gradually smooth out the differences between clinicians as the
best way of managing patients becomes more evident.
Collecting published evidence together and
analysing it often requires reviews of multiple randomised trials. These metaanalyses
involve complex statistical analyses designed to interpret multiple findings and
synthesise the results of multiple studies.