An Update From The Society of Thoracic Surgeons Workforce on Evidence-Based Surgery: Improving the Implementation of Clinical Practice Guidelines

The Society of Thoracic Surgeons (STS) has strived to use best practices in the development of clinical practice guidelines (CPGs) that reflect scientific and process standards recommended by the National Academies of Medicine (formerly Institute of Medicine) as adopted by other medical societies. The process of transitioning to a more structured and scientifically rigorous CPG development is labor intensive, time consuming, and has revealed several barriers, some of which are common to the development of any CPGs, such as managing conflicts of interest and collaborating with external societies, whereas others are more specific to surgical fields, such as lack of high-quality randomized evidence.

As a result of these challenges, STS may opt to develop true CPGs, expert consensus documents, or white papers. CPGs rely on systematic reviews and include formal, graded recommendations. Expert consensus documents should be designated when there is little to no comparative evidence available, there is no systematic review, and clinical suggestions are made that do not require use of the American College of Cardiology/ American Heart Association class of recommendations and level of evidence designations. White papers are expert opinion documents written to describe issues related to new procedures, technologies, or health policy and do not include recommendations or suggestions for practice.

The STS National Database remains one of the Society’s greatest assets to measure change in practice and outcomes over time and across the United States. To the extent that specific recommendations are captured in the database as a variable, implementation can be measured directly. Indirect evidence on the impact of CPGs may also be derived from observing temporal trends in practice patterns and outcomes before and after publication of CPGs. A better understanding of when, how, and how completely CPGs are implemented in various practice settings is currently lacking, and more research is needed to address existing hurdles in implementation of CPGs.