A. Siy1, E. Winslow1 1University Of Wisconsin,Department Of Surgery,Madison, WI, USA
Introduction: One unique method of clinical research in surgical disciplines is the surgical case series. A case series typically details the outcomes of consecutive patients operated on at a single center. Although these series lend understanding, they also have limitations. Because no reporting guidelines specific to case series exist, the elements described in their presentation are quite varied. We aimed to determine the primary areas of academic inquiry after presentation of a case series at national surgical meetings.
Methods: Abstracts of manuscripts published in Journal of the American College of Surgeons and Annals of Surgery from 2010 to 2015 were reviewed. A case series was defined as the study of a consecutive series of patients at a single institution for the purpose of describing their clinical outcomes. Those case series with accompanying discussions were analyzed. All interrogative sentences in the discussion were selected for thematic analysis and were classified by a redundant iterative process into descriptive categories.
Results: 186 case series were identified, 55 of which included the transcript for the post-presentation discussion. A total of 476 unique interrogatives were identified and classified into 4 categories and 13 subcategories. The most frequent single inquiry (20.8%) pertained to the applicability of the findings to patient care (e.g. how the data changed the author’s practice). A full 18% sought clarification of study variables (e.g. personnel involved, technical details, definitions of study terms). Nearly 7% highlighted selection bias (i.e. how patients not selected for the procedure fared in comparison). Interestingly, areas that received minimal to no attention included: cost, long-term outcomes, statistical methods, details of data collection or patient satisfaction.
Conclusion: This analysis of inquiries after presentation of surgical case series to national academic audiences highlights some areas of common concern. Of most importance is the direct applicability of the data presented to the care of patients. Specifically stating how the findings of the presented study have affected the authors’ clinical care for patients would improve face validity. In addition, defining all study variables including personnel and technical approaches is of primary interest to the audience. Finally, a description of the potential effects of selection bias on the outcomes appears to also be of major import. Addressing these areas of interest at the time of presentation of a case series is likely to improve its quality and to maximize the utility of this form of clinical research.
