Frequency of equivocation in surgical meta-evidence: a review of systematic reviews within IBD literature

Abstract

Objective: To assess the level of equivocation among level 1 evidence in ulcerative colitis and Crohn's disease and determine whether any predisposing factors are present.

Method: MEDLINE, Embase, CINHAL and Cochrane were searched from 2006 to 2017. Papers were scored using AMSTAR and categorised into surgical (S), medical (M) or medical and surgical (MS) groups. The ability of each paper to make a recommendation and conclusiveness in doing so was recorded.

Results: 278 papers were assessed. 82% (n=227) could make a recommendation, 18% (n=51) could not. There was a significant difference in ability to provide a recommendation between S and M (P=0.003) but not MS and M (P=0.022) nor S and MS (P=0.79). Where a recommendation was made, S papers were more likely to be tempered than M papers (P=0.014) but not MS papers (P=0.987).

Conclusions: Surgical meta-evidence within the inflammatory bowel disease domain is more than twice as likely as medical meta-evidence to be unable to provide a recommendation for clinical practice. Where a recommendation was made, surgical reviews were twice as likely to temper their conclusion.

Keywords: inflammatory bowel disease; surgery.

Figure 1

PRISMA paper inclusion and exclusion flow diagram. IBD, inflammatory bowel disease; M, medical intervention group; MA, meta-analysis; MS, medical and surgical intervention group; n, number of papers; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; S, surgical intervention group; SR, systematic review.