Time delay and evidence profiles forming clinical recommendations of US surgical society guidelines

Surgical society guidelines facilitate implementation of up-to-date, evidence-based care, but concerns regarding the contemporality and quality of evidence can hinder adherence. We aimed to evaluate the time gap between evidence publication and their inclusion within clinical guidelines-the publication-to-guideline delay-and characterize the quality of evidence within contemporary surgical society guidelines.

This cross-sectional study analyzed guidelines published by U.S. surgical societies between 2015 and 2020 and references informing clinical recommendations. The primary outcomes were the publication-to-guideline delay and the quality of evidence supporting clinical recommendations. Differences between societies were analyzed using the Kruskal Wallis and Fisher exact tests. All data were extracted by three reviewers, and inter-rater reliability was assessed using the Kappa coefficient.

Fifty-seven guidelines met inclusion criteria; among 6200 cited references, 3892 informed specific clinical recommendations. The median [IQR] publication-to-guideline delay was 9 [5-14] years and ranged across societies between 7 and 11 years. A majority (54%) of evidence informing recommendations comprised retrospective observational studies (54%). Despite only 14% of evidence graded as high-quality, 59% of clinical recommendations were strong. Societies showed statistically significant variations in their proportion of study designs, quality of evidence, and strength of recommendations.

U.S. surgical societies have a unique potential to disseminate evidence through guidelines. We found that concerns regarding the contemporality and quality of evidence constituting surgical guidelines may be valid. Societies should critically evaluate procedures for reviewing the timeliness and quality of evidence to ensure guidelines remain up-to-date and reliable.