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The term “evidence-based medicine” was first coined by Sackett and colleagues as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The key to practising evidence-based medicine is applying the best current knowledge to decisions in individual patients. Medical knowledge is continually and rapidly expanding. For clinicians to practise evidence-based medicine, they must have the skills to read and interpret the medical literature so that they can determine the validity, reliability, credibility and utility of individual articles. These skills are known as critical appraisal skills, and they require some knowledge of biostatistics, clinical epidemiology, decision analysis and economics, and clinical knowledge.

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Evidence Based Reviews in Surgery (EBRS) is a program jointly sponsored by the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS). The primary objective of EBRS is to help practising surgeons improve their critical appraisal skills. During the academic year, 8 clinical articles are chosen for review and discussion. They are selected for their clinical relevance to general surgeons and because they cover a spectrum of issues important to surgeons, including causation or risk factors for disease, natural history or prognosis of disease, how to quantify disease, diagnostic tests, early diagnosis and the effectiveness of treatment. A methodological article guides the reader in critical appraisal of the clinical article. Methodological and clinical reviews of the article are performed by experts in the relevant areas and posted on the EBRS website, where they are archived indefinitely.

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In addition, a listserv allows participants to discuss the monthly article. Surgeons who participate in the monthly packages can obtain Royal College of Physicians and Surgeons of Canada Maintenance of Certification credits and/or continuing medical education credits for the current article only by reading the monthly articles, participating in the listserv discussion, reading the methodological and clinical reviews and completing the monthly online evaluation and multiple choice questions. We hope readers will find EBRS useful in improving their critical appraisal skills and in keeping abreast of new developments in general surgery. Four reviews are published in condensed versions in the Canadian Journal of Surgery and 4 are published in the Journal of the American College of Surgeons. For further information about EBRS, please refer to the CAGS or ACS websites.

Questions and comments can be directed to the program administrator, Marg McKenzie, at. Key point s about the article Objective: To assess the predictive value of C-reactive protein (CRP) level for postoperative infectious complications after colorectal surgery.

Hack pln token. Data source: PubMed. Study selection: The article included all studies that analyzed the diagnostic accuracy of CRP for predicting postoperative infectious complications after colorectal surgery. Methods: Data on 1832 patients were extracted independently by the same 2 reviewers. Any discrepancies were resolved by discussion.

Each reviewer extracted true- and false-positive results and true- and false-negative results; in the 3 studies where this information was not directly available from the publications, the authors were contacted by email to request the data. All of the authors provided the additional information. For 1 study, the authors had access to the raw data. Results: Six studies were identified.

The best performance of CRP to predict postoperative infectious complications was on postoperative day 4, on which the mean CRP cutoff value was 135 ± 10 mg/L, the pooled sensitivity was 68% (95% confidence interval [CI] 57%–79%), the specificity was 83% (95% CI 77%–90%) and the negative predictive value (NPV) was 89% (95% CI 87%–92%). The pooled area under the receiver operating characteristic curve was 0.81 (95% CI 0.73–0.89). Conclusion: The meta-analysis provides compelling evidence that CRP on postoperative day 4 has a high NPV for infectious complication (89%). Therefore, CRP measurement allows safe and early discharge of selected patients after colorectal surgery. Commentary Postoperative infections remain a common cause of morbidity following colorectal procedures.