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[The practice of evidence-based medicine in surgery--evidence and experience]
Stefan Sauerland1, Bertil Bouillon, Edmund Neugebauer
1Biochemische und Experimentelle Abteilung, II. Chirurgischer Lehrstuhl, Universität zu Köln.
Introduction:
The important role of technical expertise, experience and intuition in the operative specialties may hamper both clinical research and evidence-based medicine (EBM). We assessed whether the results of EBM practice projects actually varied between surgery and medicine.
Methods:
EBM practice projects were identified through a search in Medline. We examined the proportion of questions, for which evidence was found and which led to a change in clinical management. At the same time, the proportion of randomised controlled trials (RCTs) in surgical (95) and general internal medicine (84) journals was compared.
Results:
Of the 13 EBM practice projects identified, only two dealt with surgical patients. While the proportion of answerable questions was similarly high in all projects (61% to 96%), clinical impact was lower in surgical (9% and 18%) than in medical projects (20% to 48%). Compared to medical journals, surgical journals contained fewer RCTs (3.6% vs. 2.5%; p = 0.168).
Conclusion:
The clinical impact of EBM seems to be lower in the operative specialties. This is probably due to the slightly poorer quality of surgical studies or to the difficulties of applying research results in one's own practice.
