Evidence Based Surgery

The abstract submission guidelines and an online abstract submission form will be available in November 2009. The abstract submission deadline is 5 May, 2010.

The abstracts will be evaluated along the lines of evidence based surgery (EBS). Those studies with a design conform to the upper part of the EBS pyramid will be considered for oral presentations. The apex of evidence is generally the well-conducted and suitably powered multi-center multinational double-blind placebo controlled randomized trial. In absence of this, a meta-analysis may also be considered Level I of evidence, but these are prone to poor quality reporting and inclusion of trials of poor quality. Case-series are often an exercise in publishing for the sake of publishing, or even publishing for the purpose of improving an institution’s marketing position.

It is a fact that evidence-based treatment is significantly more difficult in surgery than in some other branches of medicine. Especially randomised clinical trials (RCT’s) are difficult to run because the attachment of both doctors and patients to the familiar prevents the level of open-minded doubt necessary to achieve "equipoise", that condition of uncertainty which allows a doctor ethically to randomise the patients between competing, golden standard or placebo surgeries.  Then there is the learning process in every new operation, even for a fully trained surgeon, when unfamiliar with a particular procedure. There is inherent variation in the way in which an operation is performed by each different surgeon, which cannot be eliminated. Also surgical trials are much more difficult and expensive to run, because the commercial interest is not always a fact…

Most studies of operations have historically been retrospective series cases, with RCT’s accounting for less than 7% of the total. The paucity of meta-analysis in the surgical literature (due to lack of RCT’s) remains  indisputable.