The pros and cons of evidence-based surgery

Introduction: Evidence-based medicine (EBM) has been proposed as a new para digm of practising medicine. However, an unproductive polarisation between supporters and opponents can make its unbiased assessment difficult. This r eview gives an overview of the arguments and discusses their surgeon-specif ic importance. Discussion: As EBM claims a position in the centre of medici ne, it borders with other highly debated topics as, for instance, rationing and equity of care, doctor-patient interaction, medical research and educa tion. Most arguments against EBM relate to its role in reducing health expe nses by rationing healthcare. We think that the principles of EBM can be ap plied to make the inevitable process of rationing fair and reproducible. In addition, evidence-based surgery is criticised for interfering with patien t individuality and physician autonomy, although this is a misunderstanding . Furthermore, the evidence-basis of EBM, in particular the randomised cont rolled trial (RCT) and systematic review, has been subject of discussion. A dditionally, surgical research has its own inherent difficulties and, ultim ately, some clinicians have doubted the practical feasibility of applying E BM at the bedside, because searching and critically appraising the literatu re is too difficult and time consuming. Conclusions: We believe that most c ritics consider EBM to be a potentially dangerous tool, because they fear i t will be used against them selves. Thus, these conflicts only prove that E BM as a methodology may have a strong impact on solving them. As EBM has al ready made discernible progress, surgeons should not stand aside from these activities, which are bound to strongly influence healthcare in the next c entury.