CAGS and ACS Evidence Based Reviews in Surgery

The term “evidence-based medicine” was first coined by Sackett and colleagues as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”1 The key to practising evidencebased medicine is applying the best current knowledge to decisions in individual patients. Medical knowledge is continually and rapidly expanding. For clinicians to practise evidence-based medicine, they must have the skills to read and interpret the medical literature so that they can determine the validity, reliability, credibility and utility of individual articles. These skills are known as critical appraisal skills, and they require some knowledge of biostatistics, clinical epidemiology, decision analysis and economics, and clinical knowledge.

Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS) and is supported by an educational grant from ETHICON and ETHICON ENDO-SURGERY, both units of Johnson & Johnson Medical Products, a division of Johnson & Johnson and ETHICON Inc. and ETHICON ENDO-SURGERY Inc., divisions of Johnson & Johnson Inc. The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely. In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits for the current article only by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple choice questions.

We hope readers will find EBRS useful in improving their critical appraisal skills and in keeping abreast of new developments in general surgery. Four reviews are published in condensed versions in the Canadian Journal of Surgery and 4 are published in the Journal of the American College of Surgeons. For further information about EBRS, please refer to the CAGS or ACS websites. Questions and comments can be directed to the program administrator, Marg McKenzie, at


  1. Evidence-Based Medicine Working Group. Evidence-based medicine. JAMA 1992;268:2420-5.

Published Articles

49. Is a diverting loop ileostomy and colonic lavage an alternative to colectomy for the treatment of severe Clostridium difficile–associated disease?

48. What is the effect of screening mammography on breast cancer incidence?

47. Does the long-term use of aspirin decrease the risk of death due to cancer?

46. Cost-effectiveness of bariatric surgery for severely obese adults with diabetes

45. Impact of the 80-hour resident work week on mortality and morbidity in trauma patients

44. Is there an association between implementation of a medical team training program and surgical mortality?

43. Operative blood loss, blood transfusion and 30-day mortality in older patients after major noncardiac surgery

42. Risks of complications by attending physicians after performing nighttime procedures

41. Cost–utility analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

40. Axillary dissection versus no axillary dissection in women with invasive breast cancer and sentinel node metastasis

39. Access to emergency operative care: a comparative study between the Canadian and American health care systems

38. Guidelines for the management of Barrett esophagus with high-grade dysplasia?

37. Is there a role for prophylactic antibiotics in the prevention of urinary tract infections following Foley catheter removal in patients having abdominal surgery?

36. Effect of high perioperative oxygen fraction on surgical site infection

35. Efficacy and safety of low-dose hydrocortisone therapy in the treatment of septic shock

34. Effects of ß-blockers in patients undergoing noncardiac surgery

33. The association between colonoscopy and deaths from colorectal cancer

32. Use of a surgical safety checklist to reduce morbidity and mortality

31. The use of intensive insulin therapy and penta-starch resuscitation in patients with severe sepsis

30. Prophylactic antibiotics for mesh inguinal hernioplasty

29. Computed tomographic angiography for the diagnosis of blunt cervical vascular injury

28. Comparison of on-demand and planned relaparotomy for secondary peritonitis

27. Quality-of-life outcomes with sentinel node biopsy versus standard axillary treatment in patients with operable breast cancer

26. Watchful waiting versus repair of inguinal hernia in minimally symptomatic men

25. Perioperative chemotherapy and surgery versus surgery alone for resectable gastric cancer

24. Fast-track programs in colonic surgery

23. ASCO recommended guidelines for sentinal lymph node biopsy for early-stage breast cancer

22. The use of PET/CT scanning on the management of resectable pancreatic cancer

21. The risk of surgical site infection is reduced with perioperative oxygen

20. Small gallstones may increase the risk of pancreatitis; is there a benefit for a prophylactic cholecystecomy?

19. The effect of a decision aid on knowledge and treatment decision making for breast cancer

18. Treatment of occult pneumothoraces from blunt trauma

17. The timing of elective colectomy in diverticulitis: a decision analysis

16. Randomized trial of parathyroidectomy in mild asymptomatic primary hyperparathyroidism

15. Biphasic computed tomography with mesenteric evaluation of acute mesenteric ischemia

14. Preoperative fasting for adults to prevent perioperative complications

13. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones

12. Primary repair for penetrating colon injuries

11. Evidence-based guidelines for children with isolated spleen or liver injury

10. Laparoscopy-assisted colectomy versus open colectomy for treatment of nonmetastatic colon cancer: a randomized trial

9. Risk factors for retained foreign bodies after surgery

8. Efficacy and safety of recombinant human activated protein C for severe sepsis

7. Quality of life after bile duct injury during laparoscopic cholecystectomy

6. “GERD” as a risk factor for esophageal cancer

5. Need for preoperative radiation in rectal cancer

4. Decision analysis of total thyroidectomy versus thyroid lobectomy in low-risk, differentiated thyroid cancer

3. Helical computed tomography versus pulmonary arteriography in pulmonary embolism

2. E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi

1. Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs