How evidence-based are clinical practice guidelines in anaesthesiology: the cases of preoperative care and difficult airway management




Poster session 1


Tuesday 22 October 2019 - 12:30 to 14:00

All authors in correct order:

Ciapponi A1, Tapia López E1, Virgilio SA1, Perelli L1, Cohen Arazi H1, Bardach A1
1 Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Argentina
Presenting author and contact person

Presenting author:

Agustín Ciapponi

Contact person:

Abstract text
Background: clinical practice guidelines (CPGs) in anaesthesiology have diverse methodological quality and have used various evidence-rating systems. It is difficult to properly compare their recommendations without a systematic grading approach.

Objectives: to analyze and describe evidence-based CPGs' (EB-CPGs) approach on topics frequently addressed in anaesthesiology.

Methods: overview of EB-CPGs on two topics: general preoperative care (PC) and difficult airway (DA) management, following Cochrane methods.

Inclusion criteria:
1) description of the development expert panel;
2) use of standard methods for identification, data collection and study risk of bias assessment;
3) reporting of the level of evidence that supports each recommendation.

We searched CPGs published in the last 10 years without language limitation in the main electronic databases, meta-search engines, specific sources of CPG and consulting experts. Pairs of independent review authors selected EB-CPGs, rated their methodological quality using the AGREE-II instrument and classified the strength and the level of evidence for each recommendation according to the GRADE methodology. We resolved discrepancies by consensus.

Results: we identified 2262 references and included 16 EB-CPGs for PC and from 2591 references found for VA, we included 11 EB-CPGs. Only nine (56%) and eight (73%) respectively had searches during the last five years. The most used grading system was GRADE (44% for PC and 64% for DA). The AGREE-II average, which scores for rigour in the elaboration, was 56 ± 23%. The worst score was for the ‘applicability’ domain (25 ± 24% for PC and 37 ± 10% for DA) of this tool (Table 1). We found a low proportion of diagnostic recommendations supported by high/moderate certainty of evidence, and a relatively higher one for therapeutic/preventive recommendations. The proportion of 'strong' diagnostic recommendations were 41% to 51% and 76% respectively (Table 2). We found higher consistency among guidelines in the direction (for or against) and strength of the recommendations than in their supporting level of evidence.

Conclusions: the included EB-CPGs showed significant heterogeneity in terms of quality and rating systems. Applicability and monitoring were deficient; however, almost two-thirds of EB-CPGs were updated in the last five years. These findings reveal several opportunities for quality improvement.

Patient or healthcare consumer involvement: none, since it was a methodological paper about published guidelines.