Guideline Assessment Project II: statistical calibration informed the development of an AGREE II extension for surgical guidelines

Sofia Tsokani, Stavros A. Antoniou, Irini Moustaki, Manuel López-Cano, George A. Antoniou, Ivan D. Flórez, Gianfranco Silecchia, Sheraz Markar, Dimitrios Stefanidis, Giovanni Zanninotto, Nader K. Francis, George H. Hanna, Salvador Morales-Conde, Hendrik Jaap Bonjer, Melissa C. Brouwers, Dimitrios Mavridis

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


Objective: To inform the development of an AGREE II extension specifically tailored for surgical guidelines. Summary background data: AGREE II was designed to inform the development, reporting, and appraisal of clinical practice guidelines. Previous research has suggested substantial room for improvement of the quality of surgical guidelines. Methods: A previously published search in MEDLINE for clinical practice guidelines published by surgical scientific organizations with an international scope between 2008 and 2017, resulted in a total of 67 guidelines. The quality of these guidelines was assessed using AGREE II. We performed a series of statistical analyses (reliability, correlation and Factor Analysis, Item Response Theory) with the objective to calibrate AGREE II for use specifically in surgical guidelines. Results: Reliability/correlation/factor analysis and Item Response Theory produced similar results and suggested that a structure of 5 domains, instead of 6 domains of the original instrument, might be more appropriate. Furthermore, exclusion and re-arrangement of items to other domains was found to increase the reliability of AGREE II when applied in surgical guidelines. Conclusions: The findings of this study suggest that statistical calibration of AGREE II might improve the development, reporting, and appraisal of surgical guidelines.
Original languageEnglish
Pages (from-to)4061-4068
Number of pages8
JournalSurgical endoscopy
Issue number8
Early online date2021
Publication statusPublished - Aug 2021


  • Clinical practice guidelines
  • Methodological quality
  • Reporting quality
  • Surgery

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