Abstract
In this last dcade of the twentieth century, surgeons are finding themselves making decisions based on statistical analyses. These analyses appear regularly in professional journals and scientific presentations, but they are also used by governments and insurance companies in the formulation of health care policy documents. Mass media may disseminate this information, often ignoring serious pitfalls associated with the statistical methods used to reach the conclusions published. The consumer generally assumes that the statistical tests used in peer-reviewed journal articles are appropriate. It has been estimated, however, that up to two-thirds of the studies appearing in some of the best medical journals contain statistical errors or unwarranted conclusions. 1,2 In order to critically appraise this information, some understanding of biostatistical methods and their constraints has become essential. Education to enable surgeons to do so is being incorporated into the training of future surgeons and will be a valuable part of the continuing education of practicing surgeons. This chapter is intended to contribute to this effort, building on the information provided in earlier chapters.
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References
Sheehan TJ. The medical literature: let the reader beware. Arch Intern Med 1980;140:472–474
Gardner MJ., Machin D, Campbell MJ. Use of check lists in assessing the statistical content of medical studies. Br Med J 1986;292:810–812
Mainland D. Mathematics in medicine: statistical ritual in clinical journals. I. Is there a cure? Br Med J 1984;288:841–843
Feinstein AR. XXXVII. Demeaned errors, confidence games, nonplussed minuses, inefficient coefficients, and other statistical disruptions of scientific communication. Clin Pharmacol Ther 1976;20:617–631
Gardner MJ, Altman DG. Confidence intervals rather than p values: estimation rather than hypothesis testing. Br Med J 1986;292:746–792
Chiu RC-J. Cardioplegia: From the bedside to the laboratory and back again. Ann Thorac Surg 1991;52:209–210 Editorial
McPeek B, Mosteller F, McKneally MF, Neugebauer EAM. Experimental methods: clinical trials. In: Troidl H, Spitzer WO, McPeek B, Mulder DS, McKneally MF, Wechsler AS, Balch CM, eds. Principles and Practice of Research: Strategies for Surgical Investigators, 2nd edn. New York: Springer-Verlag, 1991, ch. 14, pp. 114–125
Freiman JA, Chalmers TC, Smith H Jr, Kueler RR. Importance of beta, the type II error, and sample size in the design and interpretation of the randomized control trial. New Engl J Med 1978;299: 690–694
Sacks H, Chalmers TC, Smith H Jr. Randomized versus historical controls for clinical trials. Am J Med 1982;72:233–240
Elenbaas JK, Cuddy PG, Elenbaas RM. Evaluating the medical literature. III. Results and discussion. Ann Emerg Med 1983;12:679–686
Oxman AD, Guyatt GH. A consumer’s guide to subgroup analyses. Ann Intern Med 1992;116: 78–84
Pocock SJ. Further aspects of data analysis. In: Clinical Trials: A Practical Approach. New York: Wiley, 1983, ch. 14, pp. 211–225
Gore SM, Jones IG, Rytter EC. Misuse of statistical methods: critical assessment of articles in BMJ from January to March 1976. Br Med J 1977;1: 85–87
Reed JF III, Slaichert W. Statistical proof in inconclusive “negative” trials. Ann Inter Med 1981;141:1307–1310
Olak J, Jeyasingham K, Forrester-Wood CF, Hutter J, al-Zeerah M, Brown E. Randomized trial of one-dose versus six-dose cefazolin prophylaxis in elective general thoracic surgery. Ann Thorac Surg 1991;51:956–958
Parmar MKB. Pitfalls and biases in the reporting and interpretation of the results of clinical trials. Lung Cancer 1994;10(1):S143–S150
Morgan PP. Confidence intervals: From statistical significance to clinical significance. CMAJ 1989; 141:881–883
Arkin CF, Wachtel MS. How many patients are necessary to assess test performance? JAMA 1990;263:275–278
Simon R. Confidence limits for reporting results of clinical trials. Ann Intern Med 1986;105:429–435
Emerson JD, McPeek B, Mosteller R. Reporting clinical trials in general surgical journals. Surgery 1984;95:572–579
Anderson RP, Bonchek LI, Grunkemeier GL, Lambert LE, Starr A. The analysis and presentation of surgical results by actuarial methods. J Surg Res 1974;16:224–230
Cutler SJ, Ederer F. Maximum utilization of the life-table method in analyzing survival. J Chron Dis 1958;8:699–712
Hess KR. Confidence intervals and survival estimates. J Thorac Cardiovasc Surg 1991;102:456–457. Letter to the editor
Kirklin JW, Blackstone EH, Naftel DC. Confidence intervals and survival estimates. J Thorac Cardiovasc Surg 1991;10:457–459. Reply from the editor
Kaplana EL, Meier P. Non-parametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–481
Detsky AS, Redelmeier D, Abrams HB. What’s wrong with decision analysis? Can the left brain influence the right? J Chron Dis 1987;40:831–836
Pauker SG, Kassirer JP. The threshold approach to clinical decision making. New Engl J Med 1980; 302:1109–1117
Elston RC, Johnson WD. Essentials of Biostatistics. Philadelphia: Davis, 1987
Gaddis ML, Gaddis GM. Introduction to biostatistics. 6. Correlation and regression. Ann Emerg Med 1990;19:1462–1468
Knapp RG: Basic Statistics for Nurses, 2nd edn. New York: John Wiley and Sons, 1985
Gehlbach SH. Interpreting the Medical Literature: Practical Epidemiology for Clinicians, 2nd edn. New York: Macmillan, 1988
Daniel WW. Biostatistics: A Foundation for Analysis in the Health Sciences. New York: John Wiley and Sons, 1974
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Olak, J., Chiu, R.CJ. (1998). A Surgeon’s Guide to Biostatistical Inferences: How to Avoid Pitfalls. In: Troidl, H., McKneally, M.F., Mulder, D.S., Wechsler, A.S., McPeek, B., Spitzer, W.O. (eds) Surgical Research. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1888-3_37
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DOI: https://doi.org/10.1007/978-1-4612-1888-3_37
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