Letter by Banack et al Regarding Article, “Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis”
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To the Editor:
A meta-analysis synthesizes published research on a given topic. In general, it provides high-quality support for a clinical question of interest and is considered the gold standard of evidence under the framework of evidence-based medicine. However, the recent study by Mariscalco and colleagues1 highlights an important problem with considering meta-analyses the highest level of evidence: if individual studies in the literature are biased, then the summary effect estimate produced by the meta-analysis may reflect the same biased value but with a smaller standard error. Summarizing reduces sampling variability, and therefore 95% confidence intervals, but …