title: Surgical practice: evidence or anecdote.
abstract: OBJECTIVE
  Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices.
  
  
  METHODS
  We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective sigmoid colectomy following 2 bouts of diverticulitis), identified the data supporting each practice, and administered a survey to faculty and residents at our institution.
  
  
  METHODS
  Wright State University Department of Surgery, Boonshoft School of Medicine, Dayton, Ohio.
  
  
  METHODS
  Twenty-one faculty and 35 residents responded to the survey.
  
  
  RESULTS
  No studies were found relating to clamping nasogastric tubes before removal. Seven faculty (33%) and 11 residents (31%) used this practice. Two faculty (10%) and 0 residents felt this was an evidence-based practice. Faculty were more likely to have reviewed the evidence (85% vs 40%, p < 0.001). Level 2 evidence has shown bowel preparation did not improve outcomes relating to anastomotic leak, wound infection, or septic complications in elective colon resection. Twenty faculty (95%) and 34 residents (97%) used this practice. Faculty were more likely to believe this to be evidence-based (85% vs 49%, p = 0.01). There has been no level 1 or 2 evidence showing that sigmoid colectomy following 2 bouts of diverticulitis improves morbidity or mortality. Fourteen faculty (70%) and 26 residents (76%) reported using this practice. Twelve faculty (60%) and 21 residents (60%) felt this was evidence-based.
  
  
  CONCLUSIONS
  Frequent use of surgical practices without evidence support can create a misperception that such practices are evidence-based. Faculty are more likely to change a practice after obtaining continuing medical education, suggesting that residents may need validation by faculty practice of evidence-based procedures before incorporation into their clinical care.
authors.affiliation: Department of Surgery, Wright State University, Boonshoft School of Medicine, One Wyoming Street, Dayton, OH 45409, USA. brent.izu@wright.edu
authors.forename: Brent S
authors.initials: BS
authors.lastname: Izu
authors.forename: Benjamin
authors.initials: B
authors.lastname: Monson
authors.forename: Alex G
authors.initials: AG
authors.lastname: Little
authors.forename: Paula M
authors.initials: PM
authors.lastname: Termuhlen
mesh_terms: D002983:Clinical Competence; D003082:Colectomy / Q000379:methods; D003250:Constriction; D004503:Education, Medical, Graduate / Q000379:methods*; D004750:Enteral Nutrition; D019317:Evidence-Based Medicine / Q000193:education / Q000379:methods; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods; D018794:Problem-Based Learning; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative / Q000193:education / Q000592:standards*; D011795:Surveys and Questionnaires; D007507:Therapeutic Irrigation