Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal.
BACKGROUND
Surgical care is an important burden in healthcare, and the complications and harm related to surgery are of special concern. Clinical practice guidelines in perioperative care should provide the opportunity to minimise these risks and improve surgical outcomes, but their quality has not yet been evaluated systematically.


OBJECTIVE
To evaluate the quality of clinical practice guidelines (CPGs) for the prevention of perioperative adverse events.


METHODS
A systematic search of scientific literature published between 1990 and 2008 was undertaken to identify and select CPGs related to the treatment of surgical patients, particularly those seeking to prevent surgical adverse events. The authors searched the main guideline databases and guideline developer websites, and completed the search in MEDLINE. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Their degree of agreement was evaluated with the intraclass correlation coefficient (ICC).


RESULTS
Twenty-two CPGs were chosen for evaluation from a total of 6181 references. The overall agreement among reviewers was moderate (ICC: 0.68; 95% CI 0.46 to 0.84). The scores for each of the AGREE domains were: scope and purpose 80.9% (range: 40.7-100%); stakeholder involvement 51.3% (range: 8.3-88.8%); rigour of development 61.2% (range: 26.9-96.8%); clarity and presentation 69.7% (range: 33.3-94.4%); applicability 42.5% (range: 7.4-92.5%); and editorial independence 57% (range: 27.7-100%). Most of the appraised guidelines could be recommended (n = 10) or recommended with provisos (n = 10) for use in clinical practice. Guidelines developed by research agencies or guideline developers were of a higher quality than those developed by scientific societies. The authors did not detect any improvement over time in guideline quality.


CONCLUSIONS
The quality of guidelines for perioperative care is moderate. Measures should be taken to guarantee that CPGs are based on the best available evidence and rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision-making in this field.
Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni M Claret 171, 08041 Barcelona, Spain. leticia.barajas@cochrane.es
Leticia
L
Barajas-Nava
Ivan
I
Solà
Mario
M
Delgado-Noguera
Ignasi
I
Gich
Carola Orrego
CO
Villagran
Xavier
X
Bonfill
Pablo
P
Alonso-Coello
D006801:Humans; D019300:Medical Errors / Q000517:prevention & control; D019990:Perioperative Care / Q000009:adverse effects / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care