BACKGROUND: The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence.
METHODS: Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition.
RESULTS: Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects.
CONCLUSIONS: When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue.
OBJECTIVE: To evaluate the evidence for interventions to decrease surgical site infections (SSIs) in colorectal operations using Bayesian meta-analysis.
BACKGROUND: Interventions other than appropriate administration of prophylactic antibiotics to prevent SSIs have not been adopted widely, in part because of lack of recommendations for these interventions based on traditional meta-analyses. Bayesian methods can provide probabilities of specific thresholds of benefit, which may be more useful in guiding clinical decision making. We hypothesized that Bayesian meta-analytic methods would complement the interpretation of traditional analyses regarding the effectiveness of interventions to decrease SSIs.
METHODS: We conducted a systematic search of the Cochrane database for reviews of interventions to decrease SSIs after colorectal surgery other than prophylactic antibiotics. Traditional and Bayesian meta-analyses were performed using RevMan (Nordic Cochrane Center, Copenhagen, Denmark) and WinBUGS (MRC Biostatistics Unit, Cambridge, UK). Bayesian posterior probabilities of any benefit, defined as a relative risk of <1, were calculated using skeptical, neutral, and enthusiastic prior probabilities. Probabilities were also calculated that interventions decreased SSIs by ≥10%, and ≥20% using neutral prior probability distributions.
RESULTS: A total of 9 Cochrane reviews met the search criteria. Using traditional meta-analysis methods, only laparoscopic colorectal surgery resulted in a significant reduction in SSIs and a recommendation for use of the intervention. Using Bayesian analysis, several interventions that did not result in "significant" decreases in SSIs using traditional analytic methods had a >85% probability of benefit. Also, nonuse of 2 interventions (mechanical bowel preparation and adhesive drapes) had a high probability of decreasing SSIs compared with their use.
CONCLUSION: Bayesian probabilities and traditional point estimates of treatment effect yield similar information in terms of potential effectiveness. Bayesian meta-analysis, however, provides complementary information on the probability of a large magnitude of effect. The clinical impact of using Bayesian methods to inform decisions about which interventions to institute first or which interventions to combine requires further study.
CONTEXT: Astma is een chronische respiratoire aandoening steeds vaker voor in de VS, met name onder kinderen en bepaalde minderheidsgroepen. Deze paraplu beoordeling gezocht om te beoordelen en bestaande systematische reviews van astma-gerelateerde interventies die kunnen worden uitgevoerd of ondersteund door de staat of de gemeenschap astma controle programma's samen te vatten, en om hiaten in kennis te identificeren.
BEWIJS AANKOOP: Elf databases werden doorzocht tot en met september 2010, met behulp van termen met betrekking tot vier concepten: astma, beoordeling, interventie, en NIET medicatie. Recensies van de effectiviteit van medicijnen, werden medische procedures, complementaire en alternatieve geneeskunde, psychologische interventies, gezinstherapie, en voedingsstoffen of voedingssupplementen uitgesloten. Twee codeurs gescreend elke record en geëxtraheerd gegevens uit de meegeleverde beoordelingen.
BEWIJS SYNTHESE: Data-analyse werd uitgevoerd van mei tot december 2010. Van 42 opgenomen reviews, 19 de effectiviteit van het onderwijs en / of self-management, negen van de vermindering van de binnenlucht triggers, negen interventies om de verstrekking van de gezondheidszorg te verbeteren, en vijf andere onderzochte interventies. Verschillende reviews gevonden consistent bewijs van effectiviteit voor zelf-management onderwijs, en een herziening vastgesteld dat uitgebreide home-based interventies, inclusief een vermindering van verschillende binnenunits astma triggers zijn effectief voor kinderen. Andere reviews gevonden beperkte of onvoldoende bewijs vanwege studie beperkingen.
CONCLUSIES: State of gemeenschap astmacontrole's moeten prioriteit (1) implementeren van interventies waarvoor de onderhavige evaluatie is gebleken bewijs van effectiviteit en (2) de evaluatie van veelbelovende interventies die nog niet adequaat beoordeeld.
The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence.
METHODS:
Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/condition.
RESULTS:
Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volume-outcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects.
CONCLUSIONS:
When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue.
