Randomized Controlled Trial Comparing Surgical Interventions

Randomized controlled trials (RCT) sit atop the hierarchy of evidence and are widely regarded as the optimal study design in evidence-based medicine. Although they are frequently used by clinicians to guide our decision-making, surgical RCTs face unique challenges that clinicians must consider when evaluating whether trial results can be applied to their practice. These include issues related to blinding, allocation concealment, and surgical expertise, which can threaten the validity of study findings. The purpose of this chapter is to equip clinicians with strategies to critically appraise RCTs comparing surgical interventions. We begin with a clinical scenario, followed by a literature search, and then guide clinicians on how to critically evaluate an RCT. We will focus on the methods, the validity of the results, and the potential impact on our clinical practice. By the end of this chapter, readers will gain a better understanding of how to critically appraise an RCT comparing surgical interventions.