Surgical Practice: Evidence or Anecdote

Brent S. Izu, Benjamin Monson, Alex G. Little, Paula M. Termuhlen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices. Design: We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective sigmoid colectomy following 2 bouts of diverticulitis), identified the data supporting each practice, and administered a survey to faculty and residents at our institution. Setting: Wright State University Department of Surgery, Boonshoft School of Medicine, Dayton, Ohio. Participants: Twenty-one faculty and 35 residents responded to the survey. Results: No studies were found relating to clamping nasogastric tubes before removal. Seven faculty (33%) and 11 residents (31%) used this practice. Two faculty (10%) and 0 residents felt this was an evidence-based practice. Faculty were more likely to have reviewed the evidence (85% vs 40%, p < 0.001). Level 2 evidence has shown bowel preparation did not improve outcomes relating to anastomotic leak, wound infection, or septic complications in elective colon resection. Twenty faculty (95%) and 34 residents (97%) used this practice. Faculty were more likely to believe this to be evidence-based (85% vs 49%, p = 0.01). There has been no level 1 or 2 evidence showing that sigmoid colectomy following 2 bouts of diverticulitis improves morbidity or mortality. Fourteen faculty (70%) and 26 residents (76%) reported using this practice. Twelve faculty (60%) and 21 residents (60%) felt this was evidence-based. Conclusions: Frequent use of surgical practices without evidence support can create a misperception that such practices are evidence-based. Faculty are more likely to change a practice after obtaining continuing medical education, suggesting that residents may need validation by faculty practice of evidence-based procedures before incorporation into their clinical care.

Original languageEnglish (US)
Pages (from-to)281-284
Number of pages4
JournalJournal of surgical education
Volume66
Issue number5
DOIs
StatePublished - Sep 1 2009

Fingerprint

Anecdotes
resident
evidence
Evidence-Based Practice
Diverticulitis
Colectomy
Sigmoid Colon
Constriction
Colon
Continuing Medical Education
Anastomotic Leak
Wound Infection
Medicine
Morbidity
Education
morbidity
surgery
Mortality

Keywords

  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Systems-Based Practice
  • diverticulitis
  • evidence-based medicine
  • mechanical bowel preparation
  • nasogastric tube
  • surgical education

Cite this

Surgical Practice : Evidence or Anecdote. / Izu, Brent S.; Monson, Benjamin; Little, Alex G.; Termuhlen, Paula M.

In: Journal of surgical education, Vol. 66, No. 5, 01.09.2009, p. 281-284.

Research output: Contribution to journalArticle

Izu, Brent S. ; Monson, Benjamin ; Little, Alex G. ; Termuhlen, Paula M. / Surgical Practice : Evidence or Anecdote. In: Journal of surgical education. 2009 ; Vol. 66, No. 5. pp. 281-284.
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abstract = "Objectives: Our objective is to highlight a few surgical practices that are not based on evidence but are still taught in surgical education, and to assess our experience with these practices. Design: We identified 3 practices (clamping of nasogastric tubes before removal, bowel preparation before elective colon resection, and elective sigmoid colectomy following 2 bouts of diverticulitis), identified the data supporting each practice, and administered a survey to faculty and residents at our institution. Setting: Wright State University Department of Surgery, Boonshoft School of Medicine, Dayton, Ohio. Participants: Twenty-one faculty and 35 residents responded to the survey. Results: No studies were found relating to clamping nasogastric tubes before removal. Seven faculty (33{\%}) and 11 residents (31{\%}) used this practice. Two faculty (10{\%}) and 0 residents felt this was an evidence-based practice. Faculty were more likely to have reviewed the evidence (85{\%} vs 40{\%}, p < 0.001). Level 2 evidence has shown bowel preparation did not improve outcomes relating to anastomotic leak, wound infection, or septic complications in elective colon resection. Twenty faculty (95{\%}) and 34 residents (97{\%}) used this practice. Faculty were more likely to believe this to be evidence-based (85{\%} vs 49{\%}, p = 0.01). There has been no level 1 or 2 evidence showing that sigmoid colectomy following 2 bouts of diverticulitis improves morbidity or mortality. Fourteen faculty (70{\%}) and 26 residents (76{\%}) reported using this practice. Twelve faculty (60{\%}) and 21 residents (60{\%}) felt this was evidence-based. Conclusions: Frequent use of surgical practices without evidence support can create a misperception that such practices are evidence-based. Faculty are more likely to change a practice after obtaining continuing medical education, suggesting that residents may need validation by faculty practice of evidence-based procedures before incorporation into their clinical care.",
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