title: Can decision making in general surgery be based on evidence? An empirical study of Cochrane Reviews.
abstract: BACKGROUND
  This empirical study analyzes the current status of Cochrane Reviews (CRs) and their strength of recommendation for evidence-based decision making in the field of general surgery.
  
  
  METHODS
  Systematic literature search of the Cochrane Database of Systematic Reviews and the Cochrane Collaboration's homepage to identify available CRs on surgical topics. Quantitative and qualitative characteristics, utilization, and formulated treatment recommendations were evaluated by 2 independent reviewers. Association of review characteristics with treatment recommendation was analyzed using univariate and multivariate logistic regression models.
  
  
  RESULTS
  Ninety-three CRs, including 1,403 primary studies and 246,473 patients, were identified. Mean number of included primary studies per CR was 15.1 (standard deviation [SD] 14.5) including 2,650 (SD 3,340) study patients. Two and a half (SD 8.3) nonrandomized trials were included per analyzed CR. Seventy-two (77%) CRs were published or updated in 2005 or later. Explicit treatment recommendations were given in 45 (48%). Presence of a treatment recommendation was associated with the number of included primary studies and the proportion of randomized studies. Utilization of surgical CRs remained low and showed large inter-country differences. The most surgical CRs were accessed in UK, USA, and Australia, followed by several Western and Eastern European countries.
  
  
  CONCLUSIONS
  Only a minority of available CRs address surgical questions and their current usage is low. Instead of unsystematically increasing the number of surgical CRs it would be far more efficient to focus the review process on relevant surgical questions. Prioritization of CRs needs valid methods which should be developed by the scientific surgical community.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. markus.diener@med.uni-heidelberg.de
authors.forename: Markus K
authors.initials: MK
authors.lastname: Diener
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wolff
authors.forename: Erik
authors.initials: E
authors.lastname: von Elm
authors.forename: Nuh N
authors.initials: NN
authors.lastname: Rahbari
authors.forename: Chris
authors.initials: C
authors.lastname: Mavergames
authors.forename: Hanns-Peter
authors.initials: HP
authors.lastname: Knaebel
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Seiler
authors.forename: Gerd
authors.initials: G
authors.lastname: Antes
mesh_terms: D002986:Clinical Trials as Topic; D016208:Databases, Factual; D003657:Decision Making; D055317:Evidence-Based Practice; D013502:General Surgery; D006801:Humans; D013514:Surgical Procedures, Operative