Quality of Clinical Practice Guidelines for Laparoscopic Surgery: Systematic Review

Abstract Aim Guidelines on laparoscopic surgery are essential for providing guidance to achieve safe and effective treatments. In this systematic review, we investigated the true extent of the grades of recommendation which were supported by evidence in the guidelines and whether this extent depended upon the quality of the guidelines. Method We searched PUBMED and EMBASE for laparoscopic surgical guidelines published between 1st March 2016 and 1st March 2019.To determine the extent of the grades of recommendation supported by evidence, we determined the disagreement in the grading between the guideline author and independent evaluation. We used the AGREE-II Tool ‘rigour of development’ and ‘clarity of presentation’ domains to assess the quality of guidelines. We performed a mixed effects generalised linear regression modelling using binary distribution and logit link in the GLIMMIX procedure of Statistical Analysis System (SAS) software. Results We analysed 1905 guideline statements from the 63 guidelines retrieved. The median of the scores for the ‘rigour of development’, ‘clarity of presentation’, the ‘editorial independence’ domains in the guidelines were 0.43, 0.72 and 0.63. The interquartile ranges were 0.094, 0.25 and 0.38. The ‘rigour of development’ domain was the only determinant of disagreement in the grades of recommendation guideline statements between the guideline authors and independent evaluation. Conclusions There is variation in the grades of recommendation in the guidelines. The ‘rigour of development’ domain can be used to predict quality of the guidelines. Guideline users should use the ‘rigour of development’ domain to assess the quality of the laparoscopic guidelines before developing local clinical policies.