“Change in culture” needed to increase RCTs in cardiothoracic surgery

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Mario Gaudino

Specialists in congenital and adult cardiac and thoracic surgery have called for a cultural change within the surgical community toward more engagement in and support for randomised controlled trials (RCTs).

In a paper published online this week in The Annals of Thoracic Surgery, Mario Gaudino (New York-Presbyterian and Weill Cornell Medicine, New York, USA) and colleagues reviewed the challenges to randomised trials in cardiothoracic surgery, discussing the key issues with surgical trials and suggesting potential solutions.

They note that clinical research in surgery faces a number of unique challenges, writing that it has “traditionally been of lower quality compared to medicine”. Issues include challenges with blinding, the learning curve for procedures, surgeon experience and difficulty in defining the appropriate timing for comparative trials. “Other issues are due to the surgical culture, the attitude of surgeons toward randomised trials and the lack of support by professional and national bodies,” they note.

Gaudino et al write: “The number of RCTs in surgical specialties, including adult and congenital cardiac and thoracic surgery, remains low and inadequate for modern standards of evidence-based practice. While some of the challenges that cardiothoracic surgery trials face are intrinsic to the nature of the field, a cultural change of the surgical community toward a more extensive engagement in and support of surgical RCTs is likely the most important step to improve the current situation.”

The paper echoes similar comments made by the president of the European Association For Cardiothoracic Surgeons (EACTS), Peter Licht (Southern Danish University, Odense, Denmark), speaking at the organisation’s annual meeting in October 2020 (EACTS 2020, 8–10 October, virtual). During his presidential address, Licht called upon cardiothoracic surgeons to participate in more randomised controlled trials to elevate the quality of research carried out in the specialty.


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