Meta-analysis of well-designed nonrandomized comparative studies of surgical procedures is as good as randomized controlled trials

Abstract Objective To compare the results of meta-analysis of nonrandomized comparative studies (NRCSs) of a surgical procedure with that of randomized controlled trials (RCTs), and to assess the effect of design and conduct issues in NRCSs on measured outcomes. Study Design and Setting Two meta-ana...

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Bibliographic Details
Published in:Journal of clinical epidemiology 2010-03, Vol.63 (3), p.238-245
Main Authors: Abraham, Ned S, Byrne, Christopher J, Young, Jane M, Solomon, Michael J
Format: Article
Language:English
Subjects:
Biological and medical sciences
Clinical trials
Colorectal cancer
Colorectal Neoplasms - surgery
Comparative studies
Confidence intervals
Controlled Clinical Trials as Topic - methods
Data collection
Data Interpretation, Statistical
Digestive system. Abdomen
Endoscopy
Epidemiology
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Internal Medicine
Intraoperative Period
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopy
Medical sciences
Meta-analysis
Meta-Analysis as Topic
Miscellaneous
Morbidity
Public health. Hygiene
Public health. Hygiene-occupational medicine
Randomized controlled trials
Randomized Controlled Trials as Topic
Reoperation
Research Design
Short-term outcomes
Standard deviation
Statistical methods
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Studies
Surgery
Total quality
Treatment Outcome
Tumors
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Summary:Abstract Objective To compare the results of meta-analysis of nonrandomized comparative studies (NRCSs) of a surgical procedure with that of randomized controlled trials (RCTs), and to assess the effect of design and conduct issues in NRCSs on measured outcomes. Study Design and Setting Two meta-analyses of RCTs and NRCSs (2,512 and 6,438 procedures, respectively) of laparoscopic resection for colorectal cancer were performed according to accepted protocols, and 13 outcomes common between them were compared. Odds ratios (ORs) and 95% confidence intervals (CI) for dichotomous outcomes were assessed for the degree of overlap. Continuous outcomes were compared using cumulative weighted ratios (CWRs) and percentages for which a mean and standard deviation (SD) were calculated. The effects of design and conduct issues in the meta-analysis of NRCSs on measured morbidity rates were assessed using subgroup analysis. Results The ORs of the three dichotomous outcomes overlapped widely. For the 10 continuous variables, the mean difference (SD) in the results of the two meta-analyses was only 5.6% (4.9%). Fulfillment of certain quality and conduct issues in the NRCSs determined the statistical homogeneity of the results of meta-analysis and their comparability with the “gold standard.” Conclusion Meta-analysis of well-designed NRCSs of surgical procedures is probably as accurate as that of RCTs.
ISSN:0895-4356
1878-5921
DOI:10.1016/j.jclinepi.2009.04.005