Importance of sequential methods in meta-analysis: implications for postoperative mortality, delirium, and stroke management

Thomas Payne; Ben Moran; John Loadsman; Ian Marschner; Tim McCulloch; Robert D Sanders

doi:10.1016/j.bja.2023.01.011

Importance of sequential methods in meta-analysis: implications for postoperative mortality, delirium, and stroke management

Br J Anaesth. 2023 Apr;130(4):395-401. doi: 10.1016/j.bja.2023.01.011.

Authors

Thomas Payne¹, Ben Moran², John Loadsman¹, Ian Marschner³, Tim McCulloch¹, Robert D Sanders⁴

Affiliations

¹ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia.
² Critical Care Program, George Institute of Global Health, Sydney, Australia; Department of Intensive Care, Gosford Hospital, Gosford, Australia; Department of Anaesthesia and Pain Medicine, Gosford Hospital, Gosford, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
³ NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
⁴ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia. Electronic address: robert.sanders@sydney.edu.au.

PMID: 36931783
DOI: 10.1016/j.bja.2023.01.011

Abstract

Trial sequential analysis is an adaptation of frequentist sequential methods that can be used to improve inferences from meta-analysis. Trial sequential analysis can help preserve type I and type II error rates at desired levels for analyses conducted before the required information size. Through three case studies recently published in the British Journal of Anaesthesia, we show how trial sequential analysis can inform the interpretation of meta-analyses. Limitations of trial sequential analysis, which also include those of the meta-analysis to which it is applied, must be carefully considered alongside its benefits.

Keywords: delirium; meta-analysis; postoperative complications; relative risk reduction; reproducibility; stroke; trial sequential analysis.

Publication types

Meta-Analysis
Editorial
Comment

MeSH terms

Delirium* / therapy
Humans
Stroke*