An explanation of PROSPECT methodology and Working Group processes can be found at the following link: https://esraeurope.org/prospect-methodology
For the prostatectomy review, the Subgroup members were:
1. Anaesthesia – Intensive Care and Peri-Operative Medicine Department, Hopital Tenon, APHP, Paris, France.
2. Médecine-Sorbonne Université, Paris, France.
3. Department of Cardiovascular Sciences, KU Leuven and University Hospital Leuven, Leuven, Belgium.
4. Université de Rennes, CHU Rennes, Inserm, INRA, CIC 1414 NuMeCan, Anaesthesia and Intensive Care Department, Rennes, France.
Prostatectomy literature search
Assessments of the quality of study methodology and reporting
All included studies were assessed for quality according to PROSPECT methodology (Joshi 2019, https://esraeurope.org/prospect-methodology). The study quality assessments for prostatectomy are summarised here: Quality assessments and level of evidence assigned to included trials.
The methodology of the PROSPECT group is unique in that the available evidence is critically assessed for current clinical relevance, considering the analgesic beneﬁt of interventions against the backdrop of basic analgesics (i.e. paracetamol and NSAIDs or COX-2-selective inhibitors), the degree of pain after surgery, and balancing the procedure-speciﬁc efﬁcacy and beneﬁts of an intervention against its general risks and invasiveness.
For recommending an analgesic, at least two RCTs have to show efficacy. Recommendations were made according to PROSPECT methodology (Joshi 2019, https://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 of the study and levels of evidence and grades of recommendation.
Recommendations from the previous review (Joshi 2015) were kept as baseline. Based on the updated systematic review, a subgroup developed draft new recommendations, which were then circulated amongst all the Working Group members for review and comments. A modified Delphi approach was used as previously described (Joshi 2019), including several rounds of individual comments followed by a round-table discussion. Once consensus was achieved, the lead author drafted the final document, which was ultimately approved by the full PROSPECT group.
The included studies have some limitations:
Other limiting factors include the possibility of selection bias by the primary reviewers, which could have developed because all studies fulfilling the search requirements were split between two reviewers. There was also a possibility of human error, in which an appropriate study could have been missed by a reviewer and excluded.
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 prostatectomy review meets the requirements of ‘Domain 3: Rigour of development’ of the AGREE II instrument: