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It's time to challenge surgical dogma with evidence-based data
1Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, NC, USA.
American Journal of Obstetrics and Gynecology
|October 2, 2003
Summary
Surgical techniques often rely on tradition rather than evidence. This study highlights that evidence-based practices, like specific wound closure methods, improve patient outcomes and cost-effectiveness, urging a shift from surgical dogma.
Area of Science:
- Surgical Techniques and Evidence-Based Medicine
Background:
- Surgical training traditionally relies on apprenticeship and the transmission of techniques based on dogma rather than scientific evidence.
- Many established surgical practices lack rigorous scientific validation.
Purpose of the Study:
- To evaluate common surgical techniques against scientific evidence.
- To advocate for evidence-based practices in surgery.
Main Methods:
- Review of existing literature and surgical dogma.
- Analysis of evidence supporting or refuting common surgical techniques for wound creation and closure.
Main Results:
- Electrocautery is preferred for wound creation despite dogma.
- Peritoneal closure offers no significant advantage over nonclosure.
- Subcutaneous tissue handling lacks a clear superior method, but suture closure aids in preventing disruption.
- Subcuticular suture closure is associated with less pain, better patient satisfaction, and is more cost-effective than staples.
Conclusions:
- Many surgical techniques require rigorous, randomized prospective trials.
- Physicians must ensure their practices are evidence-based, moving beyond adherence to surgical dogma.