Hum. Reprod. Advance Access published online on February 1, 2008
Human Reproduction, doi:10.1093/humrep/dem423
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Gynaecologic surgery from uncertainty to science: evidence-based surgery is no passing fad
1 Department of Obstetrics and Gynaecology, University of Auckland, National Women’s Health, Level 12, Auckland Hospital, Auckland, New Zealand 2 Department of Reproductive and Child Health, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK 3 Clinical Biostatistics Unit, Hospital Ramon y Cajal, Madrid, Spain
4 Correspondence address. Tel: +64-9-3737599 ext 89493; Fax: +64-9-3035969; E-mail: n.johnson{at}auckland.ac.nz
BACKGROUND: The randomized controlled trial (RCT) is the least biased measure of the effectiveness of interventions, including surgical interventions. The aim was to review the available evidence base in gynaecologic surgery, to assess what progress has been made and to determine gaps in the evidence for clinical decision-making.
METHODS: Systematic reviews involving gynaecological surgery interventions were extracted from the Cochrane Database of Systematic Reviews (Issue 2, 2007) and data were extracted for key primary outcomes from each of the randomized trials in the reviews. The reviews were categorized as to whether they had provided evidence of effectiveness for pre-defined outcomes of most relevance to patients.
RESULTS: Of 371 reviews or protocols published on the Cochrane Database of Systematic Reviews (Issue 2, 2007), only 30 were completed reviews assessing surgical interventions. Seven reviews concluded there was evidence of a significant effect (whether beneficial or harmful) of the interventions studied for pre-defined primary outcomes; 11 reviews concluded there was some evidence of significant effects for primary outcomes along with some gaps for primary outcomes; 12 reviews concluded insufficient evidence of effectiveness. Common themes of unique methodological challenges and pitfalls with trials of surgical interventions were apparent.
CONCLUSIONS: Cochrane reviews have gone a long way to establishing a sound evidence base in gynaecologic surgery: some gaps in the evidence have been eliminated and others highlighted. In general, gynaecology has been a specialty where surgical interventions have been well exposed to the scrutiny of RCTs compared with other surgical specialties.
Key words: Cochrane/gynaecology/randomized controlled trials/surgery/systematic review
Submitted on September 1, 2007; resubmitted on November 1, 2007; accepted on November 15, 2007.
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