Jiajie Yu1, Wenwen Chen1, Shidong Chen2, Pengli Jia1, Guanyue Su3, Youping Li1, Xin Sun1,4. 1. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China. 2. West China School of Medicine, Sichuan University, Chengdu, China. 3. School of Preclinical and Forensic Medicine, Sichuan University, Chengdu, China. 4. Clinical Research and Evaluation Unit, West China Hospital, Sichuan University, Chengdu, China.
Abstract
BACKGROUND: Randomized controlled trial (RCT) testing surgical intervention faced challenges due to complexities of surgery and made it more difficult for surgeons and methodologists than pharmaceutical providers to build a well-design, conduct RCT. OBJECTIVE: We conducted a cross-sectional survey to address the methodological challenges of RCTs on surgical intervention and offer potential solutions. METHODS: We searched PubMed in order to summarize 2-arm parallel randomized trials for surgical interventions published in 2013. The information regarding general characteristics, general methodological and special surgical characteristics related to surgical trials comparing alternative procedures was gathered. RESULTS: Some 200 surgical trials were identified. The extent to which these trials in design, conduct and analysis differed substantially across items. The general information about sample size calculation (77.0%), lost to follow-up (71.5%), trial registration (55.5%), protocols of trials (56.0%), implementation of randomization (59.5%), concealment of randomization (56.0%); reporting of primary outcome as P value (67.0%). Surgery special information revealed that only 21.0% of trials considered surgeons' preference, approximately 12% to 50% of them controlled the quality of surgical interventions and none evaluated the effect of the learning curve. CONCLUSION: There is much room for improvement concerning the reported designs, conduct, and analysis of surgical RCTs. Considering the difficulty of surgical RCTs, some other approaches, such as surgeons' eligibility, performance of pilot studies, or implementation of pragmatic RCTs/expertise-based trials, should be feasibly implemented to overcome the presented challenges.
BACKGROUND: Randomized controlled trial (RCT) testing surgical intervention faced challenges due to complexities of surgery and made it more difficult for surgeons and methodologists than pharmaceutical providers to build a well-design, conduct RCT. OBJECTIVE: We conducted a cross-sectional survey to address the methodological challenges of RCTs on surgical intervention and offer potential solutions. METHODS: We searched PubMed in order to summarize 2-arm parallel randomized trials for surgical interventions published in 2013. The information regarding general characteristics, general methodological and special surgical characteristics related to surgical trials comparing alternative procedures was gathered. RESULTS: Some 200 surgical trials were identified. The extent to which these trials in design, conduct and analysis differed substantially across items. The general information about sample size calculation (77.0%), lost to follow-up (71.5%), trial registration (55.5%), protocols of trials (56.0%), implementation of randomization (59.5%), concealment of randomization (56.0%); reporting of primary outcome as P value (67.0%). Surgery special information revealed that only 21.0% of trials considered surgeons' preference, approximately 12% to 50% of them controlled the quality of surgical interventions and none evaluated the effect of the learning curve. CONCLUSION: There is much room for improvement concerning the reported designs, conduct, and analysis of surgical RCTs. Considering the difficulty of surgical RCTs, some other approaches, such as surgeons' eligibility, performance of pilot studies, or implementation of pragmatic RCTs/expertise-based trials, should be feasibly implemented to overcome the presented challenges.
Authors: N Bryce Robinson; Stephen Fremes; Irbaz Hameed; Mohamed Rahouma; Viola Weidenmann; Michelle Demetres; Mahmoud Morsi; Giovanni Soletti; Antonino Di Franco; Marco A Zenati; Shahzad G Raja; David Moher; Faisal Bakaeen; Joanna Chikwe; Deepak L Bhatt; Paul Kurlansky; Leonard N Girardi; Mario Gaudino Journal: JAMA Netw Open Date: 2021-06-01