Only 36.9% of common orthopaedic procedures were supported by at least one randomized controlled trial showing surgery to be superior to a non-operative alternative.
Cross-Sectional (n=9,392)
Sí
What proportion of common orthopaedic procedures are supported by RCT evidence showing superiority over non-operative alternatives?
A minority of common orthopaedic procedures are supported by high-quality RCT evidence demonstrating superiority over non-operative alternatives.
We investigated the proportion of orthopaedic procedures supported by evidence from randomised controlled trials comparing operative procedures to a non-operative alternative. Orthopaedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked according to frequency. Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures. Included studies were categorised as "supportive" or "not supportive" of operative treatment. A risk of bias analysis was conducted for included studies using the Cochrane Collaboration's Risk of Bias tool. A total of 9,392 orthopaedic procedures were performed across the index period. 94.6% (8886 procedures) of the total volume, representing the 32 most common operative procedure categories, were used for this analysis. Of the 83 included RCTs, 22.9% (19/83) were classified as supportive of operative intervention. 36.9% (3279/8886) of the total volume of procedures performed were supported by at least one RCT showing surgery to be superior to a non-operative alternative. 19.6% (1743/8886) of the total volume of procedures performed were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative. The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.
Lim et al. (Fri,) conducted a cross-sectional in Orthopaedic surgical procedures (n=9,392). Operative orthopaedic procedures vs. Non-operative alternative was evaluated on Proportion of procedures supported by at least one RCT showing surgery to be superior to a non-operative alternative. Only 36.9% of common orthopaedic procedures were supported by at least one randomized controlled trial showing surgery to be superior to a non-operative alternative.