Meta-analysis: a practical decision making tool for surgeons.
BACKGROUND
The exponential rise in published medical research on a yearly basis demands a method to summarise best evidence towards its application to patient care in clinical practice. A robust meta-analysis is a valid tool. It is often considered to be a simple process of pooling results from different studies. This is not true. It appears that surgeons lack a reference guide to help them conduct and appraise a meta-analysis.


METHODS
This paper provides a structural framework to perform a meta-analysis. It guides the surgeon on a journey from identification of the correct clinical question to data analysis and through to producing a structured report. Statistical methods are discussed briefly as most commercial software calculates most results in the background. An example of a recent meta-analysis is given. However, important caveats are mentioned as there are limitations of the meta-analytical technique.


CONCLUSIONS
Whereas meta-analyses of homogeneous studies are the highest form of evidence, poorly conducted meta-analyses create confusion and serve to harm the patient. Surgeons practising their art in an era of evidence-based surgery need to understand the principles of meta-analyses.
Panesar
Sukhmeet S
SS
National Patient Safety Agency (NPSA), London, United Kingdom. sukhmeet.panesar@npsa.nhs.uk
Bhandari
Mohit
M
Darzi
Ara
A
Athanasiou
Thanos
T
D002986:Clinical Trials as Topic; D003627:Data Interpretation, Statistical; D003657:Decision Making; D019317:Evidence-Based Medicine / Q000592:standards*; D005260:Female; D013502:General Surgery / Q000592:standards* / Q000639:trends; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D006113:United Kingdom