Surgical care – how can new evidence be applied to clinical practice?

Evidence-based medicine should facilitate improvement in surgical patient care and thus enhance outcome. Much of the early focus of this approach has been on the appropriate use of pharmacological agents such as antibiotic prophylaxis and the prevention of deep vein thrombosis. However, although positive results from large randomized trials have been incorporated into bestpractice and disseminated widely by professional societies and articles, they have often been slowly adopted into practice [1]. Procedural specialties such as general surgery and its subspecialties, especially, have been reluctant to accept results from randomised trials evaluating perioperative care, even though such improvements are evidence based and clearly enhance patient outcome [2,3]. This article will discuss the recent improvements made in perioperative care, address barriers that prevent their widespread implementation and provide suggestions as to how these hurdles might be overcome.