An explanation of PROSPECT methodology and Working Group processes can be found at the following link: http://esraeurope.org/prospect-methodology
For the breast surgery review, the Subgroup members were:
Girish P. Joshi3
Marc Van de Velde4
The first PROSPECT review included 42 studies of interventions in non-cosmetic breast surgery (published 1966 to May 2006) (archived on the website: Non-cosmetic Breast Surgery 2006)
All included studies were assessed for quality according to Prospect methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). The study quality assessments for breast surgery are summarised here: Quality assessments and level of evidence
Recommendations were made according to PROSPECT methodology (Joshi 2019, http://esraeurope.org/prospect-methodology). This involved a grading of A–D according to the overall level of evidence, as determined by the quality of studies included, consistency of evidence and study design: Relationship between quality and source of evidence, levels of evidence and grades of recommendation.
The proposed recommendations were sent to the PROSPECT Working Group for review and comments and a modified Delphi approach was used. Once a consensus was achieved the lead authors drafted the final document, which was ultimately approved by the working group.
The limitations of this review are related to those of the included studies:
Future adequately powered studies should assess the effects of analgesic interventions not only on pain, opioid consumption, opioid-related adverse events and complications associated with the intervention but also outcome measures such as: time to ambulation; length of hospital stay; occurrence of opioid dependence; and patient-centred outcomes such as patient satisfaction or quality of recovery.
The AGREE II instrument (Brouwers 2010) is used internationally to assess the methodological rigour and transparency of practice guidelines. As far as possible, the methodology of the PROSPECT Breast Surgery review meets the requirements of ‘Domain 3: Rigour of development’ of the AGREE II instrument: