Guidelines and evidence-based recommendations in anaesthesia: where do we stand?

The need for rigour in consensus statements and guidelines

Clinical guidelines and consensus statements are an essential aid to clinical practice. However, they bring with them risks. Amongst these are the exclusion of key stakeholders, the creation of mutual self-citation networks, and a lack of rigour in implementing and documenting the consensus process. This editorial explores the challenges of producing robust consensus statements and guidelines that have impact, and identifies current frameworks for addressing these. It is important to conduct clinical consensus exercises using recognised and accepted methodologies.

Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review

BACKGROUND

Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown.

OBJECTIVE

To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery.

DESIGN

Systematic review and methodological appraisal study.

DATA SOURCES

We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives' medical societies of Anaesthesiology and developers of CPG.

ELIGIBILITY CRITERIA

CPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, and the use of routine preoperative tests were included. Methodological quality and transparency of CPG were assessed by 3 evaluators using the 6 domains of the AGREE-II tool.

RESULTS

We included 20 CPG of which 14 were classified as recommended guidelines. The domain of "applicability" scored the lowest (44%), while the domains "scope and objective" and "editorial interdependence" received the highest median scores of 93% and 97% respectively. The remaining domains received scores ranging from 44% to 84%. The top mean scored CPG in preoperative fasting was ASA 2017 (93%); among cardiac evaluation, CPG for non-cardiac surgery were CCS 2017 (91%), ESC-ESA 2014 (90%), and AHA-ACC 2014 (89%); in preoperative testing ICSI 2020 (97%).

CONCLUSIONS

In the last ten years, most published CPG in the preoperative assessment or management of adult patients undergoing elective surgery focused on preoperative fasting, cardiac assessment for non-cardiac surgery, and use of routine preoperative tests, present moderate to high methodological quality and can be recommended for their use or adaptation. Applicability and stakeholder involvement domains must be improved in the development of future guidelines.

Evaluation of the Quality of COVID-19 Guidance Documents in Anaesthesia using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument

Background

Methods

Results

Conclusions