Surgical decision-making: integrating evidence, inference, and experience.

Evidence-based medicine provides a well-developed framework for evaluation of clinical research. Well-designed and adequately powered randomized controlled trials provide the best information on therapeutic efficacy; however, extrapolation of the trials' conclusions to individual patients may be difficult, and for many important surgical problems, trial data are unavailable. A complementary approach of inferential decision-making helps address these limitations, and increases the clinician's confidence in the safety of an approach of unknown efficacy. Experience establishes norms and expectations, and emphasizes events that are uncommon but clinically important. Although it cannot eliminate uncertainty or controversy, the integration of analytic techniques of evidence, inference, and experience provides the surgeon with the best means of adapting treatment to the unique circumstances of the individual patient.