Systematic Review and Meta-analysis: A Primer for the Surgical Researchers

Abstract This study provides a comprehensive overview of systematic reviews (SRs) and meta-analyses within surgical research, emphasizing their methodological rigor, strengths, and application in evidence-based practice. It explains how SRs synthesize available evidence through prespecified protocols that minimize bias and improve reproducibility in comparison with narrative reviews. The study outlines key stages in the process, including protocol registration, structured search strategy development, independent screening, standardized data extraction, and risk of bias (ROB) assessment using tools such as RoB2, RoB in Nonrandomized Studies of Interventions-I, and the Newcastle–Ottawa Scale. Then, it details quantitative synthesis through fixed- and random-effects models, heterogeneity assessment using I ² and τ ² statistics, and strategies for sensitivity, subgroup, and meta-regression analyses. Complementary discussions address publication bias detection methods and the use of GRADE for rating the certainty of evidence. The review contextualizes these frameworks in surgical research settings where clinical heterogeneity, learning curves, and evolving techniques complicate evidence synthesis. By promoting transparency through Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 reporting and protocol preregistration in the International Prospective Register of Systematic Reviews, the text advocates reproducibility and methodological integrity. It also recognizes the evolving landscape of automation, data-visualization tools, and living SRs that enhance efficiency in rapidly advancing surgical domains. Overall, this study serves as both a conceptual primer and a practical guide for surgeons to conduct and critically appraise SRs and meta-analyses, underscoring their pivotal role in generating reliable evidence that informs clinical decision-making and surgical guideline development.