“For surgical procedures performed commonly, it is not unreasonable to expect decision-making to be based on a high level of scientific evidence. Our findings, however, show that despite 52.6% of the total procedure volume being subjected to at least one RCT, only 19.6% of performed procedures had at least one low risk of bias RCT supporting the operative treatment over non-operative alternatives. Similarly, only a minority of the procedure types were supported by higher quality RCT evidence in favour of the surgical procedure.
Our study investigated RCT-level evidence exclusively as this study design provides the least biased evidence for the efficacy and safety of an intervention though its ability to deal with confounding . This does not imply that every operative procedure requires RCT-level evidence to support its efficacy over a non-operative alternative. Large, well-designed prospective cohort studies can adequately minimise bias comparable to that of RCTs  and therefore have acceptable levels of validity in cases where an RCT may not be feasible , .
While improvements have occurred in the quantity and to a lesser extent, the quality of surgical research over the past several decades, this study confirms that, consistent with other surgical specialities, the majority of orthopaedic surgical interventions are not based on RCT evidence. The findings of this study are reflections of the current disconnect between trial evidence and orthopaedic surgical practice and its comparison to other specialities. These findings support the need for better quality RCTs to evaluate the indications for orthopaedic procedures and stakeholder discussions about the lack of support for many procedures currently being performed.”
We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, groupe…
Posted to FB on 2019-05-18 16:48:57