SURGICAL PRACTICE IS EVIDENCE BASED

Background The quality of surgical research, and particularly the relu ctance of surgeons to perform randomized controlled trials, has been c riticized. The proportion of surgical treatments supported by satisfac tory scientific evidence has not been evaluated previously. Methods A 1-month prospective audit was performed of 100 surgical inpatients adm itted under two consultants in a general surgical/vascular unit at an urban teaching hospital; the main illness and interventions were agree d through group discussions in each case. The literature concerning th e efficacy of each treatment was reviewed, and the evidence was catego rized as: (1) supported by randomized controlled trial evidence; (2) s ufficient other evidence of efficacy to make a placebo-controlled tria l unethical; or (3) neither of the above. Results Of the 100 patients studied, 95 (95 per cent confidence interval (c.i.) 89-98) received tr eatment based on satisfactory evidence (categories 1 and 2) and, of th ese, 24 patients (95 per cent c.i. 17-35) received treatments based on randomized controlled trial evidence and 71 had treatments based on o ther convincing evidence (95 per cent c.i. 62-80). Conclusion Inpatien t general surgery is 'evidence based', but the proportion of surgical treatments supported by randomized controlled trial evidence is much s maller than that found in general medicine. Some reasons for this are clear, but the extent to which surgical practice needs to be re-evalua ted is not. Current methods for classifying and describing evidence in therapeutic studies need improvement.