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ECONOMICS AND HEALTH SYSTEMS RESEARCH

Examining the Evidence in Anesthesia Literature: A Critical Appraisal of Systematic Reviews

Peter T-L. Choi, MD, FRCPC^*, Stephen H. Halpern, MD, FRCPC, Nariman Malik, BSc, Alejandro R. Jadad, MD, DPhil, FRCPC^§, Martin R. Tramèr, MD, DPhil^||, and Bernhard Walder, MD^||

Departments of Anaesthesia* and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada; the Departments of Anesthesia and Health Administration, and the University Health Network§, University of Toronto, Toronto, Canada; and the Division of Anesthesiology, Geneva University Hospitals, Geneva, Switzerland||

Address correspondence and reprint requests to Peter T-L Choi, MD, Department of Anaesthesia, McMaster University, 1200 Main Street West, Room HSC-2 U7, Hamilton, Ontario, Canada, L8N 3Z5. Address email to choip{at}mcmaster.ca

Systematic reviews are structured reviews that use scientific strategies to reduce bias in the collection, appraisal, and interpretation of relevant studies. We undertook a systematic review of published systematic reviews in perioperative medicine to summarize the areas currently covered by this type of literature, to evaluate the quality of systematic reviews in this field, and to assess some of the methodologic and reporting issues that are unique to systematic reviews. Computerized bibliographic databases, citation review, and hand searches were performed to identify eligible articles. Quality was assessed using the Overview Quality Assessment Questionnaire. Eight-two systematic reviews were found. Reviews in perioperative medicine tended to evaluate prophylactic or therapeutic interventions. No differences were seen in quality between reviews published in anesthesia and nonanesthesia journals. Nearly half of all systematic reviews had only minor or minimal flaws; however, methods can be improved with expanded search strategies, use of least two reviewers to assess each study, use of validated methods to evaluate quality, and assessment of potential sources of bias.

Implications: The quality of systematic reviews relating to perioperative medicine was examined systematically and found to be similar in quality to those in other specialties. Adoption of recently published criteria on writing and methods could further improve this type of literature.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999