Evidence-Based Surgery

Eds Toby Gordon, John Cameron

B C Decker, £99.95, pp 688, with CD ISBN 1 55009 116 6

Rating:

I was intrigued when I was asked to review Evidence-Based Surgery because precious little surgery is evidence based. Contrary to the expected short book I was confronted by a 688 page tome from the prestigious Johns Hopkins Hospital. Intended as an introduction, it is not a set of clinical guidelines, but an explanation of how sifting and using the available scientific research can influence the art of surgery.

What, for example, is the value of colostomy in the management of colonic injuries? During the second world war all colonic injuries were managed with a stoma and the results were much better than during previous wars. A paper in 1979 challenged the view that colostomy improved the outcome in all these injuries. It was then understood that the decrease in mortality was due to improved general care of the critically injured and criteria were suggested for selective primary repair of colonic injuries.

The first part of this book delves into the principles of the subject, with a look at the history of surgery, including Johns Hopkins' contribution to early evidence based surgery, followed by discussion about the stakeholder, legal, and ethical perspectives. Lord McColl contributes an interesting chapter on evidence based surgery in the United Kingdom, illustrated by a discussion on making the diagnosis of appendicitis with computed tomography. Various contributors describe how to design studies and interpret the results, discussing clinical and economic outcome measures.

The second part considers the practice of evidence based surgery, with 25 chapters on the various specialties and areas of surgery, as well as anaesthesia and pathology.

I enjoyed reading about the impact of the internet on modern surgery, allowing the patient access to unlimited information (with its benefits and dangers) and making research results more readily available to surgeons.

The book's strength is how it discusses particular clinical situations, weighing the evidence and structuring advice on patient care. This is a useful introduction to what is set to become an important topic.