Korean Journal of Anesthesiology

The Korean Society of Anesthesiologists (대한마취통증의학회)
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Introduction to systematic review and meta-analysis

  • Ahn, EunJin (Department of Anesthesiology and Pain Medicine, Inje University Seoul Paik Hospital) ;
  • Kang, Hyun (Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine)
  • Received : 2017.12.13
  • Accepted : 2018.03.14
  • Published : 2018.04.02
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Abstract

Systematic reviews and meta-analyses present results by combining and analyzing data from different studies conducted on similar research topics. In recent years, systematic reviews and meta-analyses have been actively performed in various fields including anesthesiology. These research methods are powerful tools that can overcome the difficulties in performing large-scale randomized controlled trials. However, the inclusion of studies with any biases or improperly assessed quality of evidence in systematic reviews and meta-analyses could yield misleading results. Therefore, various guidelines have been suggested for conducting systematic reviews and meta-analyses to help standardize them and improve their quality. Nonetheless, accepting the conclusions of many studies without understanding the meta-analysis can be dangerous. Therefore, this article provides an easy introduction to clinicians on performing and understanding meta-analyses.

Keywords

References

  1. Kang H. Statistical considerations in meta-analysis. Hanyang Med Rev 2015; 35: 23-32. https://doi.org/10.7599/hmr.2015.35.1.23
  2. Uetani K, Nakayama T, Ikai H, Yonemoto N, Moher D. Quality of reports on randomized controlled trials conducted in Japan: evaluation of adherence to the CONSORT statement. Intern Med 2009; 48: 307-13. https://doi.org/10.2169/internalmedicine.48.1358
  3. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet 1999; 354: 1896-900. https://doi.org/10.1016/S0140-6736(99)04149-5
  4. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009; 62: e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006
  5. Willis BH, Quigley M. The assessment of the quality of reporting of meta-analyses in diagnostic research: a systematic review. BMC Med Res Methodol 2011; 11: 163. https://doi.org/10.1186/1471-2288-11-163
  6. Chebbout R, Heywood EG, Drake TM, Wild JR, Lee J, Wilson M, et al. A systematic review of the incidence of and risk factors for postoperative atrial fibrillation following general surgery. Anaesthesia 2018; 73: 490-8. https://doi.org/10.1111/anae.14118
  7. Chiang MH, Wu SC, Hsu SW, Chin JC. Bispectral Index and non-Bispectral Index anesthetic protocols on postoperative recovery outcomes. Minerva Anestesiol 2018; 84: 216-28.
  8. Damodaran S, Sethi S, Malhotra SK, Samra T, Maitra S, Saini V. Comparison of oropharyngeal leak pressure of air-Q, i-gel, and laryngeal mask airway supreme in adult patients during general anesthesia: A randomized controlled trial. Saudi J Anaesth 2017; 11: 390-5. https://doi.org/10.4103/sja.SJA_149_17
  9. Kim MS, Park JH, Choi YS, Park SH, Shin S. Efficacy of palonosetron vs. ramosetron for the prevention of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Yonsei Med J 2017; 58: 848-58. https://doi.org/10.3349/ymj.2017.58.4.848
  10. Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression and adverse events: a systematic review and meta-analysis. Anesth Analg 2017; 125: 2019-29. https://doi.org/10.1213/ANE.0000000000002557
  11. Landoni G, Biondi-Zoccai GG, Zangrillo A, Bignami E, D'Avolio S, Marchetti C, et al. Desflurane and sevoflurane in cardiac surgery: a meta-analysis of randomized clinical trials. J Cardiothorac Vasc Anesth 2007; 21: 502-11. https://doi.org/10.1053/j.jvca.2007.02.013
  12. Lee A, Ngan Kee WD, Gin T. A dose-response meta-analysis of prophylactic intravenous ephedrine for the prevention of hypotension during spinal anesthesia for elective cesarean delivery. Anesth Analg 2004; 98: 483-90.
  13. Xia ZQ, Chen SQ, Yao X, Xie CB, Wen SH, Liu KX. Clinical benefits of dexmedetomidine versus propofol in adult intensive care unit patients: a meta-analysis of randomized clinical trials. J Surg Res 2013; 185: 833-43. https://doi.org/10.1016/j.jss.2013.06.062
  14. Ahn E, Choi G, Kang H, Baek C, Jung Y, Woo Y, et al. Palonosetron and ramosetron compared for effectiveness in preventing postoperative nausea and vomiting: a systematic review and meta-analysis. PLoS One 2016; 11: e0168509. https://doi.org/10.1371/journal.pone.0168509
  15. Ahn EJ, Kang H, Choi GJ, Baek CW, Jung YH, Woo YC. The effectiveness of midazolam for preventing postoperative nausea and vomiting: a systematic review and meta-analysis. Anesth Analg 2016; 122: 664-76. https://doi.org/10.1213/ANE.0000000000001062
  16. Yeung J, Patel V, Champaneria R, Dretzke J. Regional versus general anaesthesia in elderly patients undergoing surgery for hip fracture: protocol for a systematic review. Syst Rev 2016; 5: 66. https://doi.org/10.1186/s13643-016-0246-0
  17. Zorrilla-Vaca A, Healy RJ, Mirski MA. A comparison of regional versus general anesthesia for lumbarspine surgery: a meta-analysis of randomized studies. J Neurosurg Anesthesiol 2017; 29: 415-25. https://doi.org/10.1097/ANA.0000000000000362
  18. Zuo D, Jin C, Shan M, Zhou L, Li Y. A comparison of general versus regional anesthesia for hip fracture surgery: a meta-analysis. Int J Clin Exp Med 2015; 8: 20295-301.
  19. Ahn EJ, Choi GJ, Kang H, Baek CW, Jung YH, Woo YC, et al. Comparative efficacy of the air-q intubating laryngeal airway during general anesthesia in pediatric patients: a systematic review and meta-analysis. Biomed Res Int 2016; 2016: 6406391.
  20. Kirkham KR, Grape S, Martin R, Albrecht E. Analgesic efficacy of local infiltration analgesia vs. femoral nerve block after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Anaesthesia 2017; 72: 1542-53. https://doi.org/10.1111/anae.14032
  21. Tang Y, Tang X, Wei Q, Zhang H. Intrathecal morphine versus femoral nerve block for pain control after total knee arthroplasty: a metaanalysis. J Orthop Surg Res 2017; 12: 125. https://doi.org/10.1186/s13018-017-0621-0
  22. Hussain N, Goldar G, Ragina N, Banfield L, Laffey JG, Abdallah FW. Suprascapular and interscalene nerve block for shoulder surgery: a systematic review and meta-analysis. Anesthesiology 2017; 127: 998-1013. https://doi.org/10.1097/ALN.0000000000001894
  23. Wang K, Zhang HX. Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis. Int J Surg 2017; 46: 61-70. https://doi.org/10.1016/j.ijsu.2017.08.569
  24. Stewart LA, Clarke M, Rovers M, Riley RD, Simmonds M, Stewart G, et al. Preferred reporting items for systematic review and metaanalyses of individual participant data: the PRISMA-IPD Statement. JAMA 2015; 313: 1657-65. https://doi.org/10.1001/jama.2015.3656
  25. Kang H. How to understand and conduct evidence-based medicine. Korean J Anesthesiol 2016; 69: 435-45. https://doi.org/10.4097/kjae.2016.69.5.435
  26. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008; 336: 924-6. https://doi.org/10.1136/bmj.39489.470347.AD
  27. Dijkers M. Introducing GRADE: a systematic approach to rating evidence in systematic reviews and to guideline development. Knowl Translat Update 2013; 1: 1-9.
  28. Higgins JP, Altman DG, Sterne JA. Chapter 8: Assessing the risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions: The Cochrane Collaboration 2011; updated 2017 Jun. cited 2017 Dec 13. Available from http://handbook.cochrane.org.
  29. Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ 1998; 316: 140-4. https://doi.org/10.1136/bmj.316.7125.140
  30. Higgins JP, Altman DG, Sterne JA.Chapter 9: Assessing the risk of bias in included studies. In: Cochrane Handbook for Systematic Reviews of Interventions: The Cochrane Collaboration 2011; updated 2017 Jun. cited 2017 Dec 13. Available from http://handbook.cochrane.org.
  31. Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in metaanalysis. In: Systematic Reviews in Health Care. Edited by Egger M, Smith GD, Altman DG: London, BMJ Publishing Group. 2008, pp 285-312 .
  32. IntHout J, Ioannidis JP, Borm GF. The Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis is straightforward and considerably outperforms the standard DerSimonian-Laird method. BMC Med Res Methodol 2014; 14: 25. https://doi.org/10.1186/1471-2288-14-25
  33. Li J, Zhang Q, Zhang M, Egger M. Intravenous magnesium for acute myocardial infarction. Cochrane Database Syst Rev 2007; (2): CD002755.
  34. Thompson SG. Controversies in meta-analysis: the case of the trials of serum cholesterol reduction. Stat Methods Med Res 1993; 2: 173-92. https://doi.org/10.1177/096228029300200205
  35. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60. https://doi.org/10.1136/bmj.327.7414.557
  36. Sutton AJ, Abrams KR, Jones DR. An illustrated guide to the methods of meta-analysis. J Eval Clin Pract 2001; 7: 135-48. https://doi.org/10.1046/j.1365-2753.2001.00281.x
  37. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994; 50: 1088-101. https://doi.org/10.2307/2533446
  38. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455-63. https://doi.org/10.1111/j.0006-341X.2000.00455.x

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