Evidence-Based Decisions in Surgery

Welcome to Evidence-Based Decisions in Surgery. As a new initiative of the American College of Surgeons, this project is designed to offer established surgical practice guidelines available for surgeons at the point of care, developed from standard techniques of evidence analysis and grading of the strength of the evidence. The information is supplied in modular format and covers the diagnoses related to the twenty most frequent operations performed by general surgeons.

Surgeons have encountered barriers to implementing practice guideline recommendations into practice. Many of these surgeons have communicated their concerns about these barriers to leaders of the American College of Surgeons, thus stimulating the impetus for producing the practice guidelines modules. While practice guidelines documents are frequently lengthy and complex, finding the most appropriate documents and extracting the most relevant surgical information is difficult. The modules of Evidence-Based Decisions in Surgery extract important information and are presented in a compact format viewable on a smartphone, tablet device, or computer.

The modules have been developed by American College of Surgeons staff and been peer-reviewed by members of two groups; the Best Practices Workgroup of the College’s Board of Governors chaired by Joseph Minei MD FACS and by representatives of the Advisory Council for General Surgery chaired by Christopher Ellison MD FACS. A consensus of the reviewers was used to determine the content of each module.

The modules permit a step-by-step review of the most important surgical aspects of the pertinent established practice guidelines. The surgical recommendations are presented along with the strength of the evidence that supports the recommendations. Grading of the strength of the evidence is done according to a standard three-level scheme (Strong evidence, Moderately-Strong Evidence, and Weak Evidence). Strong evidence is drawn from randomized prospective studies and/or strong observational studies (e.g. cohort studies). Moderately-strong evidence is drawn from observational and/or retrospective medical record review studies and weak evidence is drawn from expert opinion. Grading of the evidence is done with the full understanding that the important contribution of surgical judgment in developing effective and safe treatment strategies is used for individual surgical patients. As such, the modules are intended to guide and not meant to dictate surgical practice.

Our goal is to provide valuable information to practicing surgeons. We ask that you send us your reactions and thoughts for improvement of the modules. Please send any input or comments to me at lflint@facs.org or to the Practice Guidelines Project manager, Ms. Sapna Dalal at sdalal@facs.org.

Lewis Flint MD FACS
Practice Guidelines Project Coordinator
Division of Education
American College of Surgeons