The Quality of Clinical Practice Guidelines for Preoperative Care Using the AGREE II Instrument: a Systematic Review

Overview

Journal Syst Rev

Publisher Biomed Central

Date 2020 Jul 15

PMID 32660571

Citations 2

Authors

Agustin Ciapponi

Elena Tapia-Lopez

Sacha Virgilio

Ariel Bardach

Affiliations

Soon will be listed here.

Abstract

Background: Our aim was to summarize and compare relevant recommendations from evidence-based CPGs (EB-CPGs).

Methods: Systematic review of clinical practice guidelines.

Data Sources: PubMed, EMBase, Cochrane Library, LILACS, Tripdatabase, and additional sources. In July 2017, we searched CPGs that were published in the last 10 years, without language restrictions, in electronic databases, and also searched specific CPG sources, reference lists, and consulted experts. Pairs of independent reviewers selected EB-CPGs and rated their methodological quality using the AGREE-II instrument. We summarized recommendations, its supporting evidence, and strength of recommendations according to the GRADE methodology.

Results: We included 16 EB-CPGs out of 2262 references identified. Only nine of them had searches within the last 5 years and seven used GRADE. The median (percentile 25-75) AGREE-II scores for rigor of development was 49% (35-76%) and the domain "applicability" obtained the worst score 16% (9-31%). We summarized 31 risk stratification recommendations, 21.6% of which were supported by high/moderate quality of evidence (41% of them were strong recommendations), and 16 therapeutic/preventive recommendations, 59% of which were supported by high/moderate quality of evidence (75.7% strong). We found inconsistency in ratings of evidence level. "Guidelines' applicability" and "monitoring" were the most deficient domains. Only half of the EB-CPGs were updated in the past 5 years.

Conclusions: We present many strong recommendations that are ready to be considered for implementation as well as others to be interrupted, and we reveal opportunities to improve guidelines' quality.

Citing Articles

Perioperative patient safety recommendations: systematic review of clinical practice guidelines.

Martinez-Nicolas I, Arnal-Velasco D, Romero-Garcia E, Fabregas N, Sanduende Otero Y, Leon I BJS Open. 2024; 8(6).

PMID: 39661325 PMC: 11632830. DOI: 10.1093/bjsopen/zrae143.

Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review.

Angel G, Trujillo C, Mallama M, Alonso-Coello P, Klimek M, Calvache J PLoS One. 2023; 18(2):e0272756.

PMID: 36827452 PMC: 9956602. DOI: 10.1371/journal.pone.0272756.

References

Serafini G, Ingelmo P, Astuto M, Baroncini S, Borrometi F, Bortone L . Preoperative evaluation in infants and children: recommendations of the Italian Society of Pediatric and Neonatal Anesthesia and Intensive Care (SARNePI). Minerva Anestesiol. 2013; 80(4):461-9. View

Nicholls J, Gaskin P, Ward J, Areti Y . Guidelines for preoperative investigations for elective surgery at Queen Elizabeth Hospital: effects on practices, outcomes, and costs. J Clin Anesth. 2016; 35:176-189. DOI: 10.1016/j.jclinane.2016.07.008. View

Nardella A, Pechet L, SNYDER L . Continuous improvement, quality control, and cost containment in clinical laboratory testing. Effects of establishing and implementing guidelines for preoperative tests. Arch Pathol Lab Med. 1995; 119(6):518-22. View

Garcia Gutierrez J, Bravo Toledo R . [Clinical practice guidelines on the Internet]. Aten Primaria. 2001; 28(1):74-9. PMC: 7681672. DOI: 10.1016/s0212-6567(01)78899-3. View

Hsu J, Brozek J, Terracciano L, Kreis J, Compalati E, Stein A . Application of GRADE: making evidence-based recommendations about diagnostic tests in clinical practice guidelines. Implement Sci. 2011; 6:62. PMC: 3126717. DOI: 10.1186/1748-5908-6-62. View

Gualandro D, Yu P, Caramelli B, Marques A, Calderaro D, Fornari L . 3rd Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology. Arq Bras Cardiol. 2017; 109(3 Supl 1):1-104. PMC: 5629911. DOI: 10.5935/abc.20170140. View

Treweek S, Oxman A, Alderson P, Bossuyt P, Brandt L, Brozek J . Developing and Evaluating Communication Strategies to Support Informed Decisions and Practice Based on Evidence (DECIDE): protocol and preliminary results. Implement Sci. 2013; 8:6. PMC: 3553065. DOI: 10.1186/1748-5908-8-6. View

Devereaux P, Xavier D, Pogue J, Guyatt G, Sigamani A, Garutti I . Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011; 154(8):523-8. DOI: 10.7326/0003-4819-154-8-201104190-00003. View

Weiser T, Regenbogen S, Thompson K, Haynes A, Lipsitz S, Berry W . An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008; 372(9633):139-144. DOI: 10.1016/S0140-6736(08)60878-8. View

10.

De Hert S, Staender S, Fritsch G, Hinkelbein J, Afshari A, Bettelli G . Pre-operative evaluation of adults undergoing elective noncardiac surgery: Updated guideline from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2018; 35(6):407-465. DOI: 10.1097/EJA.0000000000000817. View

11.

Nelson G, Altman A, Nick A, Meyer L, Ramirez P, Achtari C . Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part I. Gynecol Oncol. 2015; 140(2):313-22. DOI: 10.1016/j.ygyno.2015.11.015. View

12.

Johansson T, Fritsch G, Flamm M, Hansbauer B, Bachofner N, Mann E . Effectiveness of non-cardiac preoperative testing in non-cardiac elective surgery: a systematic review. Br J Anaesth. 2013; 110(6):926-39. DOI: 10.1093/bja/aet071. View

13.

Berrios-Torres S, Umscheid C, Bratzler D, Leas B, Stone E, Kelz R . Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152(8):784-791. DOI: 10.1001/jamasurg.2017.0904. View

14.

Darzi A, Abou-Jaoude E, Agarwal A, Lakis C, Wiercioch W, Santesso N . A methodological survey identified eight proposed frameworks for the adaptation of health related guidelines. J Clin Epidemiol. 2017; 86:3-10. DOI: 10.1016/j.jclinepi.2017.01.016. View

15.

Botto F, Srinathan S, Pearse R, Biccard B, Rodseth R, Sheth T . Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology. 2014; 120(3):564-78. DOI: 10.1097/ALN.0000000000000113. View

16.

Schunemann H, Wiercioch W, Brozek J, Etxeandia-Ikobaltzeta I, Mustafa R, Manja V . GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol. 2016; 81:101-110. DOI: 10.1016/j.jclinepi.2016.09.009. View

17.

Fleisher L, Fleischmann K, Auerbach A, Barnason S, Beckman J, Bozkurt B . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(24):2215-45. DOI: 10.1161/CIR.0000000000000105. View

18.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

19.

Uribe-Leitz T, Esquivel M, Molina G, Lipsitz S, Verguet S, Rose J . Projections for Achieving the Lancet Commission Recommended Surgical Rate of 5000 Operations per 100,000 Population by Region-Specific Surgical Rate Estimates. World J Surg. 2015; 39(9):2168-72. DOI: 10.1007/s00268-015-3113-6. View

20.

Duceppe E, Parlow J, MacDonald P, Lyons K, McMullen M, Srinathan S . Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery. Can J Cardiol. 2016; 33(1):17-32. DOI: 10.1016/j.cjca.2016.09.008. View