• Markus K Diener, Thomas Simon, Markus W Büchler, and Christoph M Seiler.
• Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. markus.diener@med.uni-heidelberg.de
• Langenbecks Arch Surg. 2012 Dec 1; 397 (8): 1193-9.

PurposeThis article aims to outline the framework of surgical evaluation and knowledge transfer. Therefore, special design issues affecting surgical clinical research will be discussed. Moreover, principles and challenges of knowledge transfer from research into practice will be addressed.BackgroundThe ultimate goal of academic surgery is to improve surgical and perioperative care in order to achieve the best outcomes for patients. Randomized controlled trials and reviews with and without meta-analyses are fundamental requirements for evidence-based decision making.DiscussionDespite calls for more rigorous research methods in surgery, the frequency of high-quality randomized controlled trials and systematic reviews is low. Specific methodological and design issues have to be implemented for valid evaluation of surgical procedures. Thus, general catchwords of clinical epidemiology such as timing, randomization, registration, and reporting standards demand special appraisal. Moreover, blinding methods, placebo controls, learning curves, standardized outcome assessment, and generalizability are critical design issues in surgical trials. Moreover, systematic reviews and meta-analyses are desirable for answering clinical issues or defining new research questions.ConclusionFor a rigorous evaluation of surgical procedures, a basic understanding of research methodology is urgently needed, and to improve methodological expertise, collaboration between surgeons and methodologists is encouraged.

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