Analytical Approach to the Selection of Research Topics for Gallstone Disease and Acute Cholecystitis (an Overview of Cochrane Reviews)

Abstract

Aim: description of modern methods of statistical evaluation of the world evidence base to determine the direction of promising scientific research in diagnosis and treatment of cholelithiasis and cholecystitis.Materials and methods. The umbrella review of systematic reviews and meta-analyses of the Cochrane Library has been conducted, identifying topics for which further evidence-based research is needed. The information obtained by the Cochrane expert panels through Trial Sequential Analysis (TSA), Diversity-Adjusted Required Information Size (DARIS) calculations, and Z-curve monitoring on benefit, harm, or futility boundary plots is systematized.Results. There were established multidirectional trends and significantly different levels of achievement of evidence-based results. These should be taken into account when determining the prospect of further evidence-based studies. In the context of bile duct injury between early and delayed laparoscopic cholecystectomy, number of complications between early and delayed laparoscopic cholecystectomy, small-incision cholecystectomy and laparoscopic cholecystectomy, single-port and standard four-ports cholecystectomy and low-pressure laparoscopy the required size of meta-analysis information is unlikely to be achieved — in current versions of Cochrane library DARIS is less than 1 % of required. The same applies to mortality, the probability of developing serious complications and the conversion rate of various minimally invasive procedures, as the required sample sizes (hundreds of thousands of observations) are difficult to achieve — currently range is from 0.03 to 21.9 %. On the contrary, the achieved values from the estimated DARIS in establishing the differences in the duration between minimally invasive surgery options (21.2 to 76 %), in some issues of pain management in the immediate postoperative period (43.6 to 92.6 %) and additional intraoperative anesthesia (13.7 to 14.9 %) and Z-curve monitoring give hope for their achievement in the foreseeable future. There is little prospect of continuing evidence-based studies to determine the need for intraperitoneal anesthetic instillation, differences in the duration of hospitalization after various minimally invasive surgeries, since new information is unlikely to change the conclusions of meta-analyses (the required information size has been achieved by 100 %).Conclusion. It is necessary to take into account the results of a TSA analysis of Cochrane expert groups, when choosing research topics in patients with gallstone disease and acute cholecystitis.

Keywords

• gallstone disease
• acute cholecystitis
• evidence-based medicine
• cochrane meta-analysis
• sample size calculation