Systematic reviews and meta‐analyses in coloproctology: interpretation and potential pitfalls
Abstract
A systematic review (SR) is the unbiased appraisal of systematically identified relevant studies. Implicit in its definition is a robust and scientifically valid process, and when performed as such, SR is an important clinical research tool and influence in health policy decision‐making. This educational paper outlines that, from the original prototype based on randomized trials, there are now many other types of SRs including those based on: nonrandomized comparative studies, observational studies, prognostic studies, and studies of diagnostic and screening tools. While each of these has a similar ‘anatomy’ or format, at an individual class level, there are principles specific to each SR type. Several examples from the coloproctology literature are used as case‐studies to illustrate potential pitfalls, and upon re‐analysis, often reverse or attenuate the conclusions stated in the original publication. These examples serve to emphasize the need for health professionals to understand the process of SR and meta‐analysis so that we all arrive at appropriate interpretations to the benefit of our patients.
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About one third of the articles acknowledged that searching for observational studies requires additional time and resources because of lack of specific search filters and poorly established or inconsistently used indexing terms.
“About one third of the articles acknowledged that searching for observational studies requires additional time and resources because of lack of specific search filters and poorly established or inconsistently used indexing terms [38, 39, 47, 49, 56, 58, 59, 64, 65].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
Five articles discouraged combining different study designs in meta-analyses but saw the added value of including different designs in a systematic review.
“Five articles discouraged combining different study designs in meta-analyses but saw the added value of including different designs in a systematic review [35, 38, 56, 61, 75].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
Authors agreed that combining different study designs in a meta-analysis can lead to misleading results if done without careful consideration.
“Authors agreed that combining different study designs in a meta-analysis can lead to misleading results if done without careful consideration [35, 38, 56, 70, 75, 76].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
Recommendations were made mainly on two topics: whether different study designs should be included in a systematic review; and whether different study designs should be analysed together in a single meta-analysis.
“Recommendations were made mainly on 2 topics: whether different study designs should be included in a systematic review; [29, 34, 37–39, 49, 56, 65, 73, 75] and whether different study designs should be analysed together in a single meta-analysis [8, 34, 35, 37, 38, 42, 49, 51, 56, 61, 70, 75–78].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
Most articles considered the combination of RCTs and non-randomised designs.
“Most articles considered the combination of RCTs and non-randomised designs [29, 35, 38, 39, 49, 51, 56, 61, 75, 81].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
The majority of articles advised against the use of scales but 12 articles recommended their use.
“The majority of articles advised against the use of scales but 12 articles recommended their use [29, 30, 48–50, 52, 53, 56, 66, 77, 86, 91].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
The need for complete reporting of all relevant methodological aspects as a prerequisite to assessing the risk of bias of studies was highlighted in 10 articles, and was the focus of recommendations in a publication from the MOOSE group.
“The need for complete reporting of all relevant methodological aspects as a prerequisite to assessing the risk of bias of studies was highlighted in 10 articles, [16, 33, 35, 47, 50, 56, 86, 87, 90, 91] and was the focus of recommendations in a publication from the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group [12].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
One common recommendation was to explore heterogeneity in sensitivity analyses, comparing studies stratified by design or clinical features.
“One common recommendation was to explore heterogeneity in sensitivity analyses, comparing studies stratified by design or clinical features [12, 16, 29, 34, 39, 51, 55, 56, 66, 77, 85, 100, 102].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
Many considered heterogeneity important for the decision whether to pool the data.
“Many considered heterogeneity important for the decision whether to pool the data [34, 36, 47, 55, 56, 66, 101, 103].”
From Methods to systematically review and meta-analyse observational studies: a systematic scoping review of recommendations (2018) · cites this paper as [56]
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Mueller, M., D’Addario, M., Egger, M., Cevallos, M., Dekkers, O., Mugglin, C., & Scott, P. (2018) · BMC Medical Research Methodology · doi:10.1186/s12874-018-0495-9 · Cited by 400 · see citing works
- Authors
- Wille‐Jørgensen, P., & Renehan, A. G.
- Affiliations
- University of Copenhagen (DK)
- University of Manchester (GB)
- Corresponding author
- Wille‐Jørgensen, P.
- ORCID
- Renehan, A. G.
- Venue
- Colorectal Disease
- Publisher
- Wiley
- Published
- 2007-11-14
- Volume
- 10
- Issue
- 1
- Pages
- 21-32
- ISSN
- 1462-8910 (ISSN-L)
- 1463-1318
- OpenAlex
- W2134137570
- Cited by
- 19
- References
- 76
- Citations by year
- 2024: 1 · 2022: 2 · 2021: 2 · 2020: 3 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 1 · 2014: 2 · 2012: 1
- FWCI
- 0.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Colorectal Disease (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- systematic reviews, meta-analysis, proctology, review methodology, observational studies, prognostic studies, evidence interpretation, methodological pitfalls
- MeSH terms
- Colectomy, Colorectal Surgery, Female, United Kingdom, Humans, Male, Review Literature as Topic, Sensitivity and Specificity, Colorectal Neoplasms, Meta-Analysis as Topic, Survival Analysis, Epidemiologic Studies, Randomized Controlled Trials as Topic, Proctocolectomy, Restorative, Treatment Outcome, Risk Assessment, Controlled Clinical Trials as Topic
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