Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses
Objectives This study aims to examine the prevalence of comparisons of surgery to drug regimens, the strength of evidence of such comparisons and whether surgery or the drug intervention was favoured.Design Systematic review of systematic reviews (umbrella review).Data sources Cochrane Database of S...
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/1/e076675.full |
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| author | Ewoud Schuit John P Ioannidis Emmanuel A Zavalis Anaïs Rameau Anirudh Saraswathula Joachim Vist |
| author_facet | Ewoud Schuit John P Ioannidis Emmanuel A Zavalis Anaïs Rameau Anirudh Saraswathula Joachim Vist |
| author_sort | Ewoud Schuit |
| collection | DOAJ |
| description | Objectives This study aims to examine the prevalence of comparisons of surgery to drug regimens, the strength of evidence of such comparisons and whether surgery or the drug intervention was favoured.Design Systematic review of systematic reviews (umbrella review).Data sources Cochrane Database of Systematic Reviews.Eligibility criteria Systematic reviews attempt to compare surgical to drug interventions.Data extraction We extracted whether the review found any randomised controlled trials (RCTs) for eligible comparisons. Individual trial results were extracted directly from the systematic review.Synthesis The outcomes of each meta-analysis were resynthesised into random-effects meta-analyses. Egger’s test and excess significance were assessed.Results Overall, 188 systematic reviews intended to compare surgery versus drugs. Only 41 included data from at least one RCT (total, 165 RCTs) and covered a total of 103 different outcomes of various comparisons of surgery versus drugs. A GRADE assessment was performed by the Cochrane reviewers for 87 (83%) outcomes in the reviews, indicating the strength of evidence was high in 4 outcomes (4%), moderate in 22 (21%), low in 27 (26%) and very low in 33 (32%). Based on 95% CIs, the surgical intervention was favoured in 38/103 (37%), and the drugs were favoured in 13/103 (13%) outcomes. Of the outcomes with high GRADE rating, only one showed conclusive superiority in our reanalysis (sphincterotomy was better than medical therapy for anal fissure). Of the 22 outcomes with moderate GRADE rating, 6 (27%) were inconclusive, 14 (64%) were in favour of surgery and 2 (9%) were in favour of drugs. There was no evidence of excess significance.Conclusions Though the relative merits of surgical versus drug interventions are important to know for many diseases, high strength randomised evidence is rare. More randomised trials comparing surgery to drug interventions are needed. |
| format | Article |
| id | doaj-art-ca4cd7e3a5fb48b3a127cfd5d40cc738 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-ca4cd7e3a5fb48b3a127cfd5d40cc7382025-08-20T02:13:41ZengBMJ Publishing GroupBMJ Open2044-60552024-01-0114110.1136/bmjopen-2023-076675Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analysesEwoud Schuit0John P Ioannidis1Emmanuel A Zavalis2Anaïs Rameau3Anirudh Saraswathula4Joachim Vist5University Medical Centre Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The NetherlandsMeta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USADepartment of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, SwedenSean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, New York, New York, USADepartment of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USADepartment of Learning Informatics Management and Ethics, Karolinska Institutet, Stockholm, SwedenObjectives This study aims to examine the prevalence of comparisons of surgery to drug regimens, the strength of evidence of such comparisons and whether surgery or the drug intervention was favoured.Design Systematic review of systematic reviews (umbrella review).Data sources Cochrane Database of Systematic Reviews.Eligibility criteria Systematic reviews attempt to compare surgical to drug interventions.Data extraction We extracted whether the review found any randomised controlled trials (RCTs) for eligible comparisons. Individual trial results were extracted directly from the systematic review.Synthesis The outcomes of each meta-analysis were resynthesised into random-effects meta-analyses. Egger’s test and excess significance were assessed.Results Overall, 188 systematic reviews intended to compare surgery versus drugs. Only 41 included data from at least one RCT (total, 165 RCTs) and covered a total of 103 different outcomes of various comparisons of surgery versus drugs. A GRADE assessment was performed by the Cochrane reviewers for 87 (83%) outcomes in the reviews, indicating the strength of evidence was high in 4 outcomes (4%), moderate in 22 (21%), low in 27 (26%) and very low in 33 (32%). Based on 95% CIs, the surgical intervention was favoured in 38/103 (37%), and the drugs were favoured in 13/103 (13%) outcomes. Of the outcomes with high GRADE rating, only one showed conclusive superiority in our reanalysis (sphincterotomy was better than medical therapy for anal fissure). Of the 22 outcomes with moderate GRADE rating, 6 (27%) were inconclusive, 14 (64%) were in favour of surgery and 2 (9%) were in favour of drugs. There was no evidence of excess significance.Conclusions Though the relative merits of surgical versus drug interventions are important to know for many diseases, high strength randomised evidence is rare. More randomised trials comparing surgery to drug interventions are needed.https://bmjopen.bmj.com/content/14/1/e076675.full |
| spellingShingle | Ewoud Schuit John P Ioannidis Emmanuel A Zavalis Anaïs Rameau Anirudh Saraswathula Joachim Vist Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses BMJ Open |
| title | Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses |
| title_full | Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses |
| title_fullStr | Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses |
| title_full_unstemmed | Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses |
| title_short | Availability of evidence and comparative effectiveness for surgical versus drug interventions: an overview of systematic reviews and meta-analyses |
| title_sort | availability of evidence and comparative effectiveness for surgical versus drug interventions an overview of systematic reviews and meta analyses |
| url | https://bmjopen.bmj.com/content/14/1/e076675.full |
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