克氏外科学19版Chapter 9.pdfVIP

CHAPTER 9 EVIDENCE-BASED SURGERY: CRITICALLY ASSESSING SURGICAL LITERATURE David R. Flum, Farhood Farjah, and Nader Massarweh what is the purpose of the study? what is being compared? what is the outcome of interest? what is the study design? what is the source of data? are there nonanalytic issues worthy of consideration? how were the data analyzed? are there ethical considerations? conclusions Not long ago, case series published by a single surgeon or group of surgeons reporting the results of a novel management strategy or new technique were the mainstay of communication in the surgical community. These reports highlighted surgical advances that could be applied to patients, but often reflected the best surgeons reporting their best results. Such reports represented much of the evidence base that guided surgical practice. However, with growing recognition that almost everyone will require surgery at some point in their lives, surgical disease is being increasingly considered in the context of the public’s health. From this perspective, the published experience of one surgeon becomes less relevant than evidence that describes how surgical procedures actually work in the general community, how their effectiveness compares with other strategies, and the full spectrum of outcomes needed to assess a procedure’s impact on patients and the health care system. Over the last decade, surgical health services and outcomes research has emerged as an essential approach for informing the modern surgical era with evidence. Surgical investigators apply a range of research methods to draw truths from the collective surgical experience, with the goal of integrating the best available evidence into what surgeons do in general practice. Distinct from the past era of surgical research, current efforts aim to move beyond reporting what can be done to patients to establishing what should be done for patients. Outcomes and health services research are broad terms for scientific inquirie