• Sukhmeet S Panesar, Mohit Bhandari, Ara Darzi, and Thanos Athanasiou.
• National Patient Safety Agency (NPSA), London, United Kingdom. sukhmeet.panesar@npsa.nhs.uk
• Int J Surg. 2009 Aug 1;7(4):291-6.

BackgroundThe exponential rise in published medical research on a yearly basis demands a method to summarise best evidence towards its application to patient care in clinical practice. A robust meta-analysis is a valid tool. It is often considered to be a simple process of pooling results from different studies. This is not true. It appears that surgeons lack a reference guide to help them conduct and appraise a meta-analysis.MethodsThis paper provides a structural framework to perform a meta-analysis. It guides the surgeon on a journey from identification of the correct clinical question to data analysis and through to producing a structured report. Statistical methods are discussed briefly as most commercial software calculates most results in the background. An example of a recent meta-analysis is given. However, important caveats are mentioned as there are limitations of the meta-analytical technique.ConclusionWhereas meta-analyses of homogeneous studies are the highest form of evidence, poorly conducted meta-analyses create confusion and serve to harm the patient. Surgeons practising their art in an era of evidence-based surgery need to understand the principles of meta-analyses.

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