Methodological and reporting quality assessment of network meta-analyses in anesthesiology: a systematic review and meta-epidemiological study

Purpose The scientific rigour of the conduct and reporting of anesthesiology network meta-analyses (NMAs) is unknown. This systematic review and meta-epidemiological study assessed the methodological and reporting quality of NMAs in anesthesiology. Methods We searched four databases, including MEDLINE, PubMed, Embase, and the Cochrane Systematic Reviews Database, for anesthesiology NMAs published from inception to October 2020. We assessed the compliance of NMAs against A Measurement Tool to Assess Systematic Reviews (AMSTAR-2), Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for Network Meta-Analyses (PRISMA-NMA), and PRISMA checklists. We measured the compliance across various items in AMSTAR-2 and PRISMA checklists and provided recommendations to improve quality. Results Using the AMSTAR-2 rating method, 84% (52/62) of NMAs were rated “critically low.” Quantitatively, the median [interquartile range] AMSTAR-2 score was 55 [44–69]%, while the PRISMA score was 70 [61–81]%. Methodological and reporting scores showed a strong correlation (R = 0.78). Anesthesiology NMAs had a higher AMSTAR-2 score and PRISMA score if they were published in higher impact factor journals ( P = 0.006 and P = 0.01, respectively) or followed PRISMA-NMA reporting guidelines ( P = 0.001 and P = 0.002, respectively). Network meta-analyses from China had lower scores ( P < 0.001 and P < 0.001, respectively). Neither score improved over time ( P = 0.69 and P = 0.67, respectively). Conclusion The current study highlights numerous methodological and reporting deficiencies in anesthesiology NMAs. Although the AMSTAR tool has been used to assess the methodological quality of NMAs, dedicated tools for conducting and assessing the methodological quality of NMAs are urgently required. Study registration PROSPERO (CRD42021227997); first submitted 23 January 2021.