Key result
Surgery did not show clinically relevant differences (standardized mean difference of 0.50 or above) compared to nonsurgical alternatives for pain, physical function, or quality of life in most musculoskeletal conditions.
Why the study?
The study was conducted to estimate the benefits and harms of interventions with and without surgery for musculoskeletal conditions.
Do interventions with surgery improve pain, physical function, or quality of life compared to interventions without surgery in adults with non-fracture musculoskeletal conditions?
Meta-Analysis (n=12,645)
Do interventions with surgery improve pain, physical function, or quality of life compared to interventions without surgery in adults with non-fracture musculoskeletal conditions?
Surgical interventions for non-fracture musculoskeletal conditions generally do not provide clinically relevant improvements in pain, function, or quality of life compared to non-surgical interventions at 1 year.
Supports nonsurgical first-line care for most non-fracture musculoskeletal conditions; challenges surgical indications and future trial priorities.
OBJECTIVE: To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. DESIGN: Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. STUDY SELECTION CRITERIA: RCTs (English, German, Danish, Swedish, and Norwegian) of interventions with and without surgery conducted in any setting for any non-fracture MSK condition in adults (mean age: 18+ years) evaluating the outcomes on a continuous (benefits) or count (harms) scale. Outcomes were pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. DATA SYNTHESIS: Random-effects metaanalyses for MSK conditions where there were data from at least 2 trials. RESULTS: One hundred RCTs (n = 12 645 patients) across 28 different conditions at 9 body sites were included. For 9 out of 13 conditions with data on pain (exceptions include some spine conditions), 11 out of 11 for function, and 9 out of 9 for quality of life, there were no clinically relevant differences (standardized mean difference of 0.50 or above) between interventions with and without surgery. For 13 out of 16 conditions with data on SAEs and 16 out of 16 for death, there were no differences in harms. Only 6 trials were at low risk of bias. CONCLUSION: .
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Skou et al. (2022) conducted a meta-analysis in Musculoskeletal conditions (n=12,645). Surgery vs. Nonsurgical interventions (including placebo surgery, no intervention, or active nonsurgical treatments) was evaluated on Pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. Surgery did not show clinically relevant differences (standardized mean difference of 0.50 or above) compared to nonsurgical alternatives for pain, physical function, or quality of life in most musculoskeletal conditions.
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