Radiological correction is a major limitation of this analysis, as defnitions varied substantially

The gap

Evidence profile

Sourced from the limitations and future work and inline gaps and limitations section of the source papers, classified as general, spanning 5 journals.

Supporting evidence — 6 representative gaps

• Learning curve in periacetabular osteotomy for developmental dysplasia of the hip (2026) · Bone & Joint Open · doi

  Radiological correction is a major limitation of this analysis, as defnitions var- ied substantially across studies, limiting the validity and interpretability of the pooled estimate, which should therefore be interpreted with caution. Defnitions of early compared with late experience varied widely (chronological cutofs vs CUSUM analyses), and reporting of key variables, particularly postoperative patient-reported outcome measures (PROMs), was inconsis- tent.

  generallimitationsevidence 5/5
  Keywords: defnitions radiological correction major limitation substantially across limiting validity interpretability pooled estimate interpreted caution early
• Upper Gastrointestinal Cancer Audit: A Retrospective Analysis of Patient Outcomes in North Wales (2026) · Cureus · doi

  Future work should focus on prospective data collection using a predefined audit proforma, standardized definitions of postoperative complications, Clavien-Dindo and CTCAE grading, accurate chemotherapy completion and dose-modification data, structured follow-up dates, recurrence/progression dates, and time-to-event analysis. Multicenter collaboration may improve sample size and generalizability. Prospective evaluation would also allow more rigorous assessment of perioperative optimization, prehabilitation, enhanced recovery pathways, and MDT processes.

  generalfuture workevidence 5/5
  Keywords: prospective dates future focus collection using predefined audit proforma standardized definitions postoperative complications clavien dindo
• Microvascular Free-Flap Outcomes at a Low-Volume Canadian Center: A Retrospective Analysis (2026) · Cureus · doi

  Another limitation was that this analysis only included outcomes identified during the patient’s hospital admission and did not account for long-term follow-up after discharge. There were multiple cases in which ischemia time could not be determined. Outcomes were analyzed at the institutional level and were not separated by individual surgeon, and therefore inter-surgeon variability could not be assessed. Implications for future practice and research While this study compared surgical failure rates to high-volume institutions, it did not compare surgical takeback rates, as they have not been widely reported in the literature.

  generallimitationsevidence 5/5
  Keywords: outcomes surgeon surgical rates limitation included identified patient hospital admission account long term follow discharge
• Effects of FMEA-based bleeding risk-stratified nursing on recovery process and safety after coronary angiography (2026) · Frontiers in Public Health · doi

  Third, follow-up was limited to 30 days postoperatively, focusing primarily on in-hospital recov- ery trajectories and short-term safety outcomes; the long-term effects of the FMEA-based nursing model on patients’ quality of life, cardiovascular events, and sustained functional maintenance remain unclear. implementation experience, and patient case mix may differ from those at other institutions, and the generalisability of our findings should be validated through multicentre studies. Fourth, although we achieved systematic risk stratification and differentiated inter- vention at the nursing level, intraoperative variables were not incorporated into the stratification model; the interactions of these factors with postoperative bleeding risk warrant further exploration.

  generalinline gapsevidence 5/5
  Keywords: term nursing model risk stratification third follow limited days postoperatively focusing primarily hospital recov trajectories
• Inferiorly Based Björk Flap and Accidental Decannulation in Surgical Tracheostomy: A Single-Institution Cohort Study and Meta-Analysis (2026) · Medical Sciences · doi

  all studies included in the meta-analysis were retrospective and observational, with inherent risk of confounding by indication that meta-analytic pooling cannot fully address - surgical technique standardization across centers was variable - outcome definitions differed across studies, requiring interpretive grouping into composite endpoints, which likely contributed to the observed heterogeneity - the two zero-event safety outcomes could not be formally pooled, representing an analytic limitation that simultaneously constitutes a reassuring safety signal - the institutional pre/post-protocol comparison was subject to temporal confounding from concurrent improvements in nursing care, ICU practice, and monitoring technology over the 15-year study period - no included study was a randomized controlled trial, and prospective randomized comparison with sufficient sample size for accidental decannulation as a primary endpoint remains the highest-priority evidence gap - the reduction in the institutional cohort from 1485 screened patients to a 424-patient analytic subset introduces a risk of selection bias, and patient-level covariates were incompletely captured and could not be…

  generallimitations sectionevidence 5/5
  Keywords: all studies included meta-analysis were retrospective observational inherent
• Impact of Intravenous Tranexamic Acid on Postoperative Complications in Gender-Affirming Mastectomy: A Focus on Drain Output and Duration (2026) · Aesthetic Plastic Surgery · doi

  retrospective single-center design and the relatively small sample size may limit the generalizability of the findings - TXA administration was not randomized but based on an intraoperative surgeon's judgment, introducing potential confounding by indication - limited sample size, and low number of major bleeding events, adjusted multivariable analyses were not performed - variations in individual surgical techniques, patient anatomy, or perioperative management could have influenced complication rates despite standardized protocols

  generallimitations sectionevidence 5/5
  Keywords: retrospective single-center design relatively small sample size limit

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