International Society for Minimally Invasive Cardiothoracic Surgery Consensus Statements: Definitions and Terms of Reference

RATIONALE Effective evidence-based clinical guidelines can improve quality of care by decreasing inappropriate practice and improving transfer of new knowledge and technologies into practice. 1–3 As evidenced by the plethora of existing guidelines, there has been much expenditure of time and resources in creating clinical guidelines over the past two decades.4 However, the quality of these guidelines has ranged from poor to exceptional, and there has been distrust among potential users of guidelines who experience confusion as to which guidelines are reliable.1,4,17–26 The Conference on Guideline Standardization (COGS) has defined a gold standard for guideline reporting to promote guideline quality and facilitate guideline implementation.5 The standards given by the COGS were drawn primarily from the Institute of Medicine clinical guideline elements6 and from other existing instruments used for critical appraisal of clinical practice guidelines, including the AGREE instrument.7,8 Until recently, few clinical guidelines existed in the area of surgery and perioperative medicine. To mitigate this gap and to promote evidence-based practice in minimally invasive cardiothoracic surgery, the International Society for Minimally Invasive Cardiothoracic Surgery (ISMICS) has made efforts to develop international consensus statements that are based on rigorous appraisal of the best available clinical research, interjected by clinical expertise and opinion (explicitly declared as such) only when the evidence is insufficient to address the issue at hand. To date, two areas of controversy in minimally invasive cardiothoracic surgery have been addressed through ISMICS Consensus Statements: (1) off-pump coronary artery bypass grafting in lowand high-risk patients,9 and (2) endoscopic venous harvesting for coronary bypass grafting.10,11 Future consensus statements will continue to address areas of innovation or controversy of high relevance in this field. ISMICS consensus statements strive to meet all of the elements set out by COGS. The following addresses the details of the ISMICS consensus process and congruence with COGS.