Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review

Gustavo Angel, Cristian Trujillo, Mario Mallama, Pablo Alonso-Coello, Markus Klimek, Jose A. Calvache*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
12 Downloads (Pure)


Background Clinical practice guidelines (CPG) are statements that provide recommendations regarding the approach to different diseases and aim to increase quality while decreasing the risk of complications in health care. Numerous guidelines in the field of perioperative care have been published in the previous decade but their methodological quality and transparency are relatively unknown. Objective To critically evaluate the transparency and methodological quality of published CPG in the preoperative assessment and management of adult patients undergoing elective surgery. Design Systematic review and methodological appraisal study. Data sources We searched for eligible CPG published in English or Spanish between January 1, 2010, and June 30, 2022, in Pubmed MEDLINE, TRIP Database, Embase, the Cochrane Library, as well as in representatives’ medical societies of Anaesthesiology and developers of CPG. Eligibility criteria CPG dedicated on preoperative fasting, cardiac assessment for non-cardiac surgery, and the use of routine preoperative tests were included. Methodological quality and transparency of CPG were assessed by 3 evaluators using the 6 domains of the AGREE-II tool. Results We included 20 CPG of which 14 were classified as recommended guidelines. The domain of "applicability" scored the lowest (44%), while the domains "scope and objective" and "editorial interdependence" received the highest median scores of 93% and 97% respectively. The remaining domains received scores ranging from 44% to 84%. The top mean scored CPG in preoperative fasting was ASA 2017 (93%); among cardiac evaluation, CPG for noncardiac surgery were CCS 2017 (91%), ESC-ESA 2014 (90%), and AHA-ACC 2014 (89%); in preoperative testing ICSI 2020 (97%). Conclusions In the last ten years, most published CPG in the preoperative assessment or management of adult patients undergoing elective surgery focused on preoperative fasting, cardiac assessment for non-cardiac surgery, and use of routine preoperative tests, present moderate to high methodological quality and can be recommended for their use or adaptation. Applicability and stakeholder involvement domains must be improved in the development of future guidelines.

Original languageEnglish
Article numbere0272756
JournalPLoS ONE
Issue number2 Feburary
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
This work was supported by departmental funding (Department of Anesthesiology, Universidad del Cauca, Colombia, and Department of Anesthesiology, Erasmus University Medical Centre Rotterdam, The Netherlands). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Assistance with the study: The authors are grateful to the Medical Library, Erasmus University Medical Centre Rotterdam for assistance with the literature search. Presentation: Preliminary data for this study were presented as a poster presentation at the Colombian Society of Anesthesiology meeting, 5–7 August 2021.

Publisher Copyright:
© 2023 Angel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Dive into the research topics of 'Methodological transparency of preoperative clinical practice guidelines for elective surgery. Systematic review'. Together they form a unique fingerprint.

Cite this