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Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal
  1. Leticia Barajas-Nava1,
  2. Ivan Solà1,
  3. Mario Delgado-Noguera1,2,
  4. Ignasi Gich1,3,
  5. Carola Orrego Villagran4,
  6. Xavier Bonfill1,3,
  7. Pablo Alonso-Coello1,3
  1. 1Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Spain
  2. 2Clinical Epidemiology Unit, University of Cauca, Popayan, Colombia
  3. 3CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Spain
  1. Correspondence to Mrs Leticia Andrea Barajas Nava, Iberoamerican Cochrane Centre, Clinical Epidemiology and Public Health Department, Hospital de la Santa Creu i Sant Pau, Sant Antoni Ma Claret 171, 08041 Barcelona, Spain; leticia.barajas{at}


Background Surgical care is an important burden in healthcare, and the complications and harm related to surgery are of special concern. Clinical practice guidelines in perioperative care should provide the opportunity to minimise these risks and improve surgical outcomes, but their quality has not yet been evaluated systematically.

Objective To evaluate the quality of clinical practice guidelines (CPGs) for the prevention of perioperative adverse events.

Materials and methods A systematic search of scientific literature published between 1990 and 2008 was undertaken to identify and select CPGs related to the treatment of surgical patients, particularly those seeking to prevent surgical adverse events. The authors searched the main guideline databases and guideline developer websites, and completed the search in MEDLINE. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Their degree of agreement was evaluated with the intraclass correlation coefficient (ICC).

Results Twenty-two CPGs were chosen for evaluation from a total of 6181 references. The overall agreement among reviewers was moderate (ICC: 0.68; 95% CI 0.46 to 0.84). The scores for each of the AGREE domains were: scope and purpose 80.9% (range: 40.7–100%); stakeholder involvement 51.3% (range: 8.3–88.8%); rigour of development 61.2% (range: 26.9–96.8%); clarity and presentation 69.7% (range: 33.3–94.4%); applicability 42.5% (range: 7.4–92.5%); and editorial independence 57% (range: 27.7–100%). Most of the appraised guidelines could be recommended (n=10) or recommended with provisos (n=10) for use in clinical practice. Guidelines developed by research agencies or guideline developers were of a higher quality than those developed by scientific societies. The authors did not detect any improvement over time in guideline quality.

Conclusions The quality of guidelines for perioperative care is moderate. Measures should be taken to guarantee that CPGs are based on the best available evidence and rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision-making in this field.

  • Practice guidelines
  • surgery
  • perioperative care
  • safety management
  • adverse event
  • assessment
  • clinical practice guidelines
  • patient safety
  • surgery

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  • Funding CIBER de Epidemiología y Salud Pública (CIBERESP), Spain and the Agencia de Calidad del Sistema Nacional de Salud, Ministerio de Salud (Spain).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.