Key result
Extended VTE prophylaxis after abdominopelvic surgery lacks robust evidence with a median Fragility Index of 1.5.
Why the study?
This methodological survey was designed to assess the fragility of the evidence for extended venous thromboembolism prophylaxis following major abdominopelvic surgery.
Is the evidence for extended VTEp following major abdominopelvic surgery robust as assessed by the Fragility Index?
Systematic Review
Is the evidence for extended VTEp following major abdominopelvic surgery robust as assessed by the Fragility Index?
Statistically significant differences reported in RCTs evaluating extended VTE prophylaxis following major abdominopelvic surgery are highly fragile and may not be robust.
Answers are grounded in this paper and cite their sources.
Caution advised for extended VTE prophylaxis in abdominopelvic surgery; challenges robustness of current RCT evidence and supports larger, lower-attrition trials.
BACKGROUND: Fragility Index (FI) is increasingly used to assess robustness of statistically significant p-values reported in randomized controlled trials (RCTs). FI represents the lowest number of non-events changed to events that would make study findings non-significant. This methodological survey was designed to assess the fragility of the evidence for extended VTEp following major abdominopelvic surgery. METHODS: MEDLINE, Embase, and CENTRAL were searched from inception to November 2023. RCTs with parallel, double-armed, superiority design comparing extended VTEp for patients undergoing major abdominopelvic surgery to controls with at least one statistically significant dichotomous outcome were included. Walsh et al.'s method of calculating FI was utilized. RESULTS: After review of 611 citations, 6 RCTs were identified with 12 statistically significant outcomes between groups. The mean number of patients randomized per RCT was 419 (SD 176). The median FI was 1.5 (range: 1-4). The number of patients lost to follow-up was greater than the FI for 10/12 (83.3 %) outcomes. CONCLUSIONS: Statistically significant differences reported in RCTs evaluating extended VTEp following major abdominopelvic surgery are not robust.
No takes yet. Share an insight, caveat, or question.
McKechnie et al. (2024) conducted a systematic review in major abdominopelvic surgery. Extended VTE prophylaxis vs. controls was evaluated on Fragility Index (Median FI 1.5). Extended VTE prophylaxis following major abdominopelvic surgery had a median Fragility Index of 1.5, with loss to follow-up exceeding the FI in 83.3% of outcomes, indicating findings are not robust.
Synapse has enriched 10 related papers. Consider them for comparative context: