Evidence-based surgical practice in academic medical centers: consistently anecdotal?

Randomized trials, meta-analyses, and guidelines form the basis of clinical decision making. We queried a small sample of surgeons at three academic medical centers to determine whether key elements of surgical practice were concordant with available evidence.

A French Society of Digestive Surgery (FSDS) questionnaire was submitted to general surgery trainees and faculty at the University of South Florida and University of Chicago and to surgical oncology fellows at the Memorial Sloan-Kettering Cancer Center. Participants were asked to respond "never," "rarely," "often," or "always" to 13 questions involving different aspects of gastrointestinal surgery. For each question, a correct evidence-based answer was available from published studies.

One hundred ten surgeons (79% of eligible participants) completed the survey. Only 60% of the answers were concordant with existing data. The percentages of correct answers did not differ significantly according to institution or level of experience of participants. The low frequency of correct responses in our subjects paralleled the findings from the 2004 FSDS study. Variability in the quality of evidence and ambiguity in the survey questions may have influenced the responses, but evidence-based medicine does not appear to uniformly influence clinical decision making.