Evidence-based surgical practice: the use of intraoperative anti-adhesion agents

Surgeons are increasingly required to use both the best available evidence and their expertise in clinical decision making. With the growing number of published research papers, finding this evidence is not always straightforward and, without a proper search technique, it can be very time consuming. Once the surgeon has located the evidence, the study methodology needs to be appraised to determine whether it contains any weaknesses that could bias the reported results. Having established the robustness of the evidence, the surgeon then needs to decide whether the evidence will help to provide patient care. In this article, a five-step approach to evidence-based practice is described, providing the surgeon with a systematic method for finding, appraising and utilizing the highest level of evidence. A clinical scenario is used to illustrate the evidence-based practice steps, taking the reader through the process of formulating a question, searching the literature for evidence and, finally, carrying out a critical appraisal of a systematic review and meta-analysis.