BACKGROUND: The evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions.
METHODS: Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist.
RESULTS: The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (53·8 per cent) were rated as low risk of bias.
CONCLUSION: This overview of reviews highlights the need for more and better research in this field.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
OBJETIVO: Evaluar sistemáticamente la evidencia a través de las especialidades quirúrgicas en cuanto a si las grapas o suturas mejor mejorar los resultados del paciente y el nivel de proveedor.
DISEÑO: Una revisión sistemática de las revisiones sistemáticas y meta-análisis panorámico de estimaciones agrupadas.
RESULTADOS: Once revisiones sistemáticas, incluyendo 13.661 observaciones, cumplieron los criterios de inclusión. En suturas en cirugía ortopédica resultaron ser preferible, y para suturas tocón appendicial eran de protección tanto contra la infección del sitio quirúrgico y complicaciones postoperatorias. Sin embargo, las grapas eran de protección contra fuga en la anastomosis ilecolic. Para todos los otros tipos de cirugía la evidencia no es concluyente con intervalos de confianza más amplios incluyendo el posiblemente de resultados preferenciales para la infección del sitio quirúrgico o complicación posquirúrgica, ya sea para las grapas o suturas. Mientras que los exámenes mostraron variación sustancial en las diferencias de medias en el tiempo de funcionamiento (I (2) 94%) no había evidencia clara de una reducción en el tiempo de operación promedio de todos los tipos de cirugía. Pocas opiniones informaron la duración de la estancia, pero los tres comentarios que hicieron (I (2) 0%, incluyendo 950 observaciones) mostraron una reducción no significativa en la duración de la estancia, pero mostraron evidencia de sesgo de publicación (P-valor para la prueba Egger 0.05 ).
CONCLUSIONES: La evidencia a través de las especialidades quirúrgicas indica que el cierre de heridas con grapas reduce el tiempo quirúrgico medio. A pesar de que incluyen varios miles de observaciones, hay pruebas claras de la superioridad surgió, ya sea para las grapas o suturas con respecto a la infección del sitio quirúrgico, complicaciones post quirúrgicas, o duración de la estancia.
The evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions.
METHODS:
Systematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist.
RESULTS:
The 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (48·1 per cent) included RCTs alone, 79 (74·5 per cent) included at least one RCT and 25 (23·6 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 30·3 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (53·8 per cent) were rated as low risk of bias.
CONCLUSION:
This overview of reviews highlights the need for more and better research in this field.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
