Evidence-based surgery: The obstacles and solutions

Area of Science:

• Surgical Research Methodology
• Evidence-Based Medicine
• Clinical Trial Design

Background:

• Surgeons historically lag in adopting evidence-based medicine (EBM) and high-quality research tools.
• While surgical literature quality improves, widespread evidence-based surgery (EBS) practice remains suboptimal.
• EBS faces unique hurdles distinct from those in general EBM.

Discussion:

• Randomized controlled trials (RCTs) in surgery present specific methodological difficulties.
• Limitations include patient recruitment, blinding, and the complexity of surgical interventions.
• Ethical considerations and the heterogeneity of surgical procedures complicate RCT design and execution.

Key Insights:

• Despite improvements, the integration of evidence-based principles into surgical practice is slow.
• The inherent complexities of surgical procedures pose significant challenges to conducting rigorous RCTs.
• Addressing these obstacles is crucial for advancing evidence-based surgery.

Outlook:

• Developing innovative RCT designs tailored for surgical contexts is essential.
• Interdisciplinary collaboration can help overcome current limitations.
• Future efforts should focus on practical solutions to enhance the quality and adoption of evidence-based surgical practices.