Background

Cardiac assessment in noncardiac surgery clinical practice guidelines should be supported by the highest-quality evidence such as that offered by systematic reviews. Currently, the methodological and reporting quality of these studies remains unknown.

Methods

We used PubMed to search for all clinical practice guidelines related to perioperative cardiovascular patients undergoing noncardiac surgery from 2010 to 2021. The included clinical practice guidelines were analysed for all systematic reviews and meta-analyses. The primary objective of this study was to determine reporting and methodological quality using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2) instruments. Our secondary objective was to compare systematic reviews conducted by the Cochrane Collaboration with non-Cochrane studies.

Results

Three clinical practice guidelines were included in our study. Within these, 78 systematic reviews were included. PRISMA completion ranged from 34.8% to 100.0% with a mean of 76.9%. AMSTAR-2 completion ranged from 15.6% to 96.9% with a mean of 58.0%. Fifty-four systematic reviews underpinned a clinical practice guidelines recommendation, of which 25 were rated ‘critically low’ by AMSTAR-2 appraisal. Cochrane systematic reviews typically performed better than non-Cochrane studies, but were a minority of the included studies (10/78).

Conclusion

We found deficiencies in several key areas regarding the methodological and reporting qualities of systematic reviews included in cardiac assessment in noncardiac surgery clinical practice guidelines. As these clinical practice guidelines are instrumental to clinical decision-making and patient care in cardiac assessment in noncardiac surgery, we advocate for improved reporting quality among systematic reviews cited as supportive evidence for these recommendations.

中文翻译：

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系统评价的方法学质量，包括非心脏手术心血管风险评估和管理的临床实践指南

背景

非心脏手术临床实践指南中的心脏评估应得到最高质量证据的支持，例如系统评价提供的证据。目前，这些研究的方法学和报告质量仍然未知。

方法

我们使用 PubMed 搜索与 2010 年至 2021 年期间接受非心脏手术的围手术期心血管患者相关的所有临床实践指南。所有系统评价和荟萃分析都分析了纳入的临床实践指南。本研究的主要目的是使用 PRISMA（系统评价和元分析的首选报告工具）和 AMSTAR-2（系统评价评估工具-2）来确定报告和方法学质量。我们的次要目标是比较 Cochrane 协作组与非 Cochrane 研究进行的系统评价。

结果

我们的研究包括三项临床实践指南。其中包括 78 篇系统评价。PRISMA 完成率为 34.8% 至 100.0%，平均为 76.9%。AMSTAR-2 完成率为 15.6% 至 96.9%，平均为 58.0%。54 篇系统评价支持了临床实践指南的建议，其中 25 篇被 AMSTAR-2 评估评为“极低”。Cochrane 系统评价通常比非 Cochrane 研究表现更好，但在纳入研究中占少数 (10/78)。

结论

我们发现在非心脏手术临床实践指南中心脏评估中系统评价的方法和报告质量的几个关键领域存在缺陷。由于这些临床实践指南有助于非心脏手术心脏评估中的临床决策和患者护理，因此我们主张在被引用为这些建议的支持性证据的系统评价中提高报告质量。