TY - JOUR
T1 - Procedural Surgical RCTs in Daily Practice
T2 - Do Surgeons Adopt or Is It Just a Waste of Time?
AU - Oberkofler, Christian E.
AU - Hamming, Jacob F.
AU - Staiger, Roxane D.
AU - Brosi, Philippe
AU - Biondo, Sebastiano
AU - Farges, Olivier
AU - Legemate, Dink A.
AU - Morino, Mario
AU - Pinna, Antonio D.
AU - Pinto-Marques, Hugo
AU - Reynolds, John V.
AU - Campos, Ricardo Robles
AU - Rogiers, Xavier
AU - Soreide, Kjetil
AU - Puhan, Milo A.
AU - Clavien, Pierre Alain
AU - Rinkes, Inne Borel
N1 - Publisher Copyright:
© 2019 Lippincott Williams and Wilkins. All rights reserved.
PY - 2019/11
Y1 - 2019/11
N2 - OBJECTIVE: To assess the adoption of recommendation from randomized clinical trials (RCTs) and investigate factors favoring or preventing adoption.BACKGROUND: RCT are considered to be the cornerstone of evidence-based medicine by representing the highest level of evidence. As such, we expect RCT's recommendations to be followed rigorously in daily surgical practice.METHODS: We performed a structured search for RCTs published in the medical and surgical literature from 2009 to 2013, allowing a minimum of 5-year follow-up to convincingly test implementation. We focused on comparative technical or procedural RCTs trials addressing the domains of general, colorectal, hepatobiliary, upper gastrointestinal and vascular surgery. In a second step we composed a survey of 29 questions among ESA members as well as collaborators from their institutions to investigate the adoption of surgical RCTs recommendation.RESULTS: The survey based on 36 RCTs (median 5-yr citation index 85 (24-474), from 21 different countries, published in 15 high-ranked journals with a median impact factor of 3.3 (1.23-7.9) at the time of publication. Overall, less than half of the respondents (47%) appeared to adhere to the recommendations of a specific RCT within their field of expertise, even when included in formal guidelines. Adoption of a new surgical practice was favored by watching videos (46%) as well as assisting live operations (18%), while skepticism regarding the methodology of a surgical RCT (40%) appears to be the major reason to resist adoption.CONCLUSION: In conclusion, surgical RCTs appear to have moderate impact on daily surgical practice. While RCTs are still accepted to provide the highest level of evidence, alternative methods of evaluating surgical innovations should also be explored.
AB - OBJECTIVE: To assess the adoption of recommendation from randomized clinical trials (RCTs) and investigate factors favoring or preventing adoption.BACKGROUND: RCT are considered to be the cornerstone of evidence-based medicine by representing the highest level of evidence. As such, we expect RCT's recommendations to be followed rigorously in daily surgical practice.METHODS: We performed a structured search for RCTs published in the medical and surgical literature from 2009 to 2013, allowing a minimum of 5-year follow-up to convincingly test implementation. We focused on comparative technical or procedural RCTs trials addressing the domains of general, colorectal, hepatobiliary, upper gastrointestinal and vascular surgery. In a second step we composed a survey of 29 questions among ESA members as well as collaborators from their institutions to investigate the adoption of surgical RCTs recommendation.RESULTS: The survey based on 36 RCTs (median 5-yr citation index 85 (24-474), from 21 different countries, published in 15 high-ranked journals with a median impact factor of 3.3 (1.23-7.9) at the time of publication. Overall, less than half of the respondents (47%) appeared to adhere to the recommendations of a specific RCT within their field of expertise, even when included in formal guidelines. Adoption of a new surgical practice was favored by watching videos (46%) as well as assisting live operations (18%), while skepticism regarding the methodology of a surgical RCT (40%) appears to be the major reason to resist adoption.CONCLUSION: In conclusion, surgical RCTs appear to have moderate impact on daily surgical practice. While RCTs are still accepted to provide the highest level of evidence, alternative methods of evaluating surgical innovations should also be explored.
KW - adoption of recommendations
KW - citation index
KW - clinical impact
KW - impact factor
KW - randomized controlled trial
KW - surgery
KW - Attitude of Health Personnel
KW - United States
KW - Humans
KW - Evidence-Based Medicine
KW - Forecasting
KW - Randomized Controlled Trials as Topic
KW - Surgical Procedures, Operative/standards
KW - Outcome Assessment, Health Care
KW - Practice Patterns, Physicians'/trends
KW - Adaptation, Psychological
KW - Practice Guidelines as Topic
UR - http://www.scopus.com/inward/record.url?scp=85072707430&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003546
DO - 10.1097/SLA.0000000000003546
M3 - Article
C2 - 31634176
AN - SCOPUS:85072707430
SN - 0003-4932
VL - 270
SP - 727
EP - 734
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -