Methodological overview of systematic reviews to establish the evidence base for emergency general surgery

BackgroundThe evidence for treatment decision-making in emergency general surgery has not been summarized previously. The aim of this overview was to review the quantity and quality of systematic review evidence for the most common emergency surgical conditions. MethodsSystematic reviews of the most common conditions requiring unplanned admission and treatment managed by general surgeons were eligible for inclusion. The Centre for Reviews and Dissemination databases were searched to April 2014. The number and type (randomized or non-randomized) of included studies and patients were extracted and summarized. The total number of unique studies was recorded for each condition. The nature of the interventions (surgical, non-surgical invasive or non-invasive) was documented. The quality of reviews was assessed using the AMSTAR checklist. ResultsThe 106 included reviews focused mainly on bowel conditions (42), appendicitis (40) and gallstone disease (17). Fifty-one (481 per cent) included RCTs alone, 79 (745 per cent) included at least one RCT and 25 (236 per cent) summarized non-randomized evidence alone. Reviews included 727 unique studies, of which 303 per cent were RCTs. Sixty-five reviews compared different types of surgical intervention and 27 summarized trials of surgical versus non-surgical interventions. Fifty-seven reviews (538 per cent) were rated as low risk of bias. ConclusionThis overview of reviews highlights the need for more and better research in this field. Evidence still limited