What are the steps in a surgical systematic review?

Surgery involves understanding the pathophysiology of conditions and introducing interventions to change their course. Modern surgeons must use high-quality evidence from systematic reviews to provide patient care. This process involves reading and interpreting reviews, assessing relevant literature, reproducible assessments, summarizing results, and weighing benefits against risks and costs. This helps surgeons make treatment recommendations, considering patient values and preferences and ensures the best possible care for patients.

Introduction

A surgical systematic review involves a rigorous and structured process to synthesize and analyze the available evidence on a specific surgical intervention. Here are the general steps involved in conducting a surgical systematic review:

Define the Research Question:

• Clearly articulate the research question or objective of the systematic review. This should be specific, well-defined, and focused on a particular surgical intervention or procedure.

Protocol Development:

• Develop a detailed protocol outlining the methods and procedures that will be followed during the review. This should include inclusion and exclusion criteria, search strategies, data extraction methods, and the criteria for assessing the quality of studies.

Literature Search:

• Conduct a comprehensive and systematic literature search to identify all relevant studies. Utilize multiple databases, grey literature, conference proceedings, and other sources to minimize publication bias.

Study Selection:

• Apply pre-defined inclusion and exclusion criteria to screen and select studies. This process is typically conducted in two stages: screening titles and abstracts, followed by a full-text review of potentially relevant articles.

Data Extraction:

• Develop a standardized form for extracting relevant data from included studies. This may include information on study design, patient characteristics, interventions, outcomes, and methodological quality. Data extraction is typically performed independently by two reviewers.

Quality Assessment:

• Evaluate the methodological quality of the included studies. This can involve using tools specific to the study design (e.g., the Cochrane Risk of Bias tool for randomized controlled trials) to assess the risk of bias.

Data Synthesis:

• Perform a qualitative synthesis of the findings, summarizing the characteristics and results of the included studies. If feasible and appropriate, consider a quantitative meta-analysis to pool data and calculate summary effect estimates.

Assessment of Heterogeneity:

• Evaluate the heterogeneity among the included studies. This involves examining variations in study populations, interventions, and outcomes. Statistical methods, such as the I-squared statistic, may be used to quantify heterogeneity.

Publication Bias Assessment:

• Assess the potential for publication bias, which occurs when studies with positive results are more likely to be published than those with negative results. This can be done through visual inspection of funnel plots or statistical tests.

Interpretation of Results:

• Interpret the results in the context of the research question, taking into account the quality of the evidence, consistency of findings, and potential biases. Discuss the implications for clinical practice and future research.

Report Writing:

• Prepare a comprehensive report following established reporting guidelines (e.g., PRISMA for systematic reviews). The report should include details on the methods, results, and conclusions of the review.

Peer Review and Publication:

• Submit the systematic review for peer review to ensure the quality and validity of the methods and findings. Once accepted, publish the review in a reputable scientific journal.

Throughout the process, it's crucial to adhere to established guidelines for systematic reviews and meta-analysis, such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additionally, involving experts in the field and utilizing tools like Covidence or RevMan for systematic reviews can enhance the transparency and rigour of the review process.

Conclusion

In conclusion, the systematic review process in surgical research is a meticulous journey that demands precision and adherence to established methodologies. By formulating a clear research question, developing a robust protocol, and conducting a comprehensive literature search, researchers can identify and assess the available evidence. Rigorous study selection, data extraction, and quality assessment ensure the validity of synthesized findings. Whether through qualitative synthesis or quantitative meta-analysis, the results provide a comprehensive overview of the current state of knowledge on a specific surgical intervention. Pubrica provides Careful interpretation, consideration of limitations, and adherence to reporting guidelines, contributing to the value of the review, ultimately guiding clinical practice and shaping future research endeavours.