The Effect of Level I Evidence on Surgical Decision Making in the United States Versus Canada.

J Am Acad Orthop Surg Glob Res Rev

Department of Orthopedic Surgery, New England Baptist Hospital, Boston, MA (Dr. Jawa, Carducci, Dr. Bhandari); Department of Orthopedic Surgery, the University of Alabama at Birmingham Hospital, Birmingham, AL (Dr. Pittman); Boston Sports and Shoulder Center, Waltham, MA (Dr. Jawa, Mr. Carducci); North Shore University Hospital, Manhasset, NY (Dr. Koenig); the Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada (Dr. Bhandari); and the Department of Orthopedic Surgery, Boston University Medical Center, Boston, MA (Dr. Tornetta).

Published: December 2018

Background: In this study, we examined the difference that randomized trials favoring either surgery or nonsurgical treatment had on the surgical indications of American versus Canadian surgeons.

Methods: One randomized trial favoring surgical management of clavicle fractures and another one favoring nonsurgical management of Achilles tendon ruptures were used. American and Canadian orthopaedic surgeons were surveyed regarding their surgical indications for these injuries.

Results: More than 2000 US and 200 Canadian responses were received. For clavicles, 57% of US respondents indicated that the trial changed their practice, with 64% operating on more fractures, compared with Canadians at 78% and 68%, respectively. For Achilles, 37% of US respondents indicated that the trial changed their practice, with 29% operating on fewer ruptures, compared with Canadians at 72% and 67%, respectively.

Conclusion: American surgeons seem more willing to alter their practice to "evidence-based" indications for a trial that favors surgery rather than one that does not.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336576PMC
http://dx.doi.org/10.5435/JAAOSGlobal-D-18-00056DOI Listing

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