Benefits and Harms of Interventions With Surgery Compared to Interventions Without Surgery for Musculoskeletal Conditions: A Systematic Review With Meta-analysis

Objective To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. Design Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). Literature Search MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. Study Selection Criteria RCTs (English, German, Danish, Swedish, and Norwegian) of interventions with and without surgery conducted in any setting for any non-fracture MSK condition in adults (mean age: 18+ years) evaluating the outcomes on a continuous (benefits) or count (harms) scale. Outcomes were pain, self-reported physical function, quality of life, serious adverse events (SAEs), and death at 1 year. Data Synthesis Random-effects metaanalyses for MSK conditions where there were data from at least 2 trials. Results One hundred RCTs (n = 12 645 patients) across 28 different conditions at 9 body sites were included. For 9 out of 13 conditions with data on pain (exceptions include some spine conditions), 11 out of 11 for function, and 9 out of 9 for quality of life, there were no clinically relevant differences (standardized mean difference of 0.50 or above) between interventions with and without surgery. For 13 out of 16 conditions with data on SAEs and 16 out of 16 for death, there were no differences in harms. Only 6 trials were at low risk of bias. Conclusion The low certainty of evidence does not support recommending surgery over nonsurgical alternatives for most MSK conditions with available RCTs. Further high-quality RCTs may change this conclusion. J Orthop Sports Phys Ther 2022;52(6):312?344. doi:10.2519/jospt.2022.11075 ; Objective To estimate the benefits and harms of interventions with and without surgery for musculoskeletal (MSK) conditions. Design Intervention systematic review with meta-analysis of randomized controlled trials (RCTs). Literature Search MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL, all up to January 7, 2021. Study Selection Criteria RCTs (English, German, ...