• Keng Siang Lee, John J Y Zhang, NgaVincent Diong WengVDWDivision of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore., Cheng Han Ng, Bee Choo Tai, HigginsJulian P TJPTBristol Medical School, University of Bristol, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; NIHR Bristol Biomedical Research Centre at University Hospitals, and Nicholas L Syn.
• Bristol Medical School, University of Bristol, Bristol, United Kingdom; Division of Neurosurgery, Department of Surgery, National University Hospital, National University Health System, Singapore.
• World Neurosurg. 2022 May 1; 161: 291-302.e1.

AbstractNeurosurgeons today are inundated with rapidly amassing neurosurgical research publications. Systematic reviews and meta-analyses have consequently surged in popularity because, when executed properly, they constitute a high level of evidence and may save busy neurosurgeons many hours of combing and reviewing the literature for relevant articles. Meta-analysis refers to the quantitative (and discretionary) component of systematic reviews. It involves applying statistical techniques to combine effect sizes from multiple studies, which might offer more actionable insights than a systematic review without meta-analysis. Well-executed meta-analyses may prove instructive for clinical practice, but poorly conducted ones sow confusion and have the potential to cause harm. Unfortunately, recent audits have found the conduct and reporting of meta-analyses in neurosurgery (but also other surgical disciplines) to be relatively lackluster in methodologic rigor and compliance to established guidelines. Some of these deficiencies can be easily remedied through better awareness and adherence to prescribed standards-which will be reviewed in this article-but others stem from inherent problems with the source data (e.g., poor reporting of original research) as well as unique constraints faced by surgery as a field (e.g., lack of equipoise for randomized trials, or existence of learning curves for novel surgical procedures, which can lead to temporal heterogeneity), which may require unconventional tools (e.g., cumulative meta-analysis) to address. Therefore, it is also our goal to take stock of the unique issues encountered by surgeons who do meta-analysis and to highlight various techniques-some of which less well-known-to address such challenges.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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