AB176. SOH25_AB_116. Zero-event trials in surgical meta-analyses
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AB176. SOH25_AB_116. Zero-event trials in surgical meta-analyses

Omer Al Kindi1, Abdulaziz Alenezi1, Aoibheann Walsh2, Aoife Lowery2, Stewart Redmond Walsh2

1Department of Surgery, University of Galway, Galway, Ireland; 2Discipline of Surgery, Lambe Institute for Translational Research, University of Galway, Galway, Ireland

Background: Systematic reviews of surgical trials often identify small trials with no observed event in either trial arm (zero-event trials). These complicate subsequent meta-analyses and can either be excluded or included through the addition of a token event rate to each arm (usually 0.1). This study aimed to evaluate the current handling of zero-event trials in published surgical meta-analyses.

Methods: Meta-analyses published in the British Journal of Surgery and Annals of Surgery between January 2021 and December 2023 were retrieved. Methods sections were reviewed for specific methodological consideration of zero-event trial handling. Where zero-event trials were handled by exclusion, the analysis was repeated to include the zero-event trials by adding 0.1 to each arm. The impact on the effect size estimate was recorded.

Results: The search identified 120 meta-analyses published between January 2021 and December 2023. Specific methodology to address zero-event trials was included in 5 (4%). Zero-event trials were included in 21 meta-analyses (17%), 2 (19%) with specific approaches detailed in the methods section. Zero-event trials were commonly handled by exclusion.

Conclusions: Zero-event trials are commonly encountered in surgical evidence synthesis. Specific methods to address the effect of zero-event trials are often omitted from surgical meta-analyses.

Keywords: Research methodology; statistical analysis; statistical significance; surgical meta-analyses; zero-event trials

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab176
Cite this abstract as: Al Kindi O, Alenezi A, Walsh A, Lowery A, Walsh SR. AB176. SOH25_AB_116. Zero-event trials in surgical meta-analyses. Mesentery Peritoneum 2025;9:AB176.

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