Table 6.
Summary of findings
| What is the effectiveness of vasectomy performed by medical students compared to vasectomy performed by doctors? | ||||||
|---|---|---|---|---|---|---|
| Patient or population: patients with vasectomy | ||||||
| Setting: Chulalongkorn Hospital, Bangkok, Thailand (Bunyaratavej et al. [25]) | ||||||
| Intervention: Medical students performing vasectomy | ||||||
| Comparison: Doctors performing vasectomy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Doctors performing vasectomy | Medical students performing vasectomy | |||||
| Complication rates during surgery1 | See comment | See comment2 | Not estimable | 463 (1 study) | ⊕⊕⊕⊝ moderate3 | |
| Early post-operative complication rates (within 7 days)4 | 43 per 1000 | 33 per 1000 (13 to 85) | RR 0.78 (0.31 to 1.99) | 456 (1 study) | ⊕⊕⊝⊝ low,5 | |
| Post-operative oligospermia rates (after 3 months)6 | 29 per 1000 | 76 per 1000 (25 to 225) | RR 2.59 (0.87 to 7.70) | 322 (1 study) | ⊕⊕⊝⊝ low4,7 | |
| Unintended pregnancy rates8 - not measured | See comment | See comment | Not estimable8 | - | See comment | |
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence.
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
1Defined as errors made in identifying and resecting the vas deferens.
2No complications found in either group.
3Downgraded because of unclear risk of contamination and blinding.
4Complications included bleeding (ecchymosis and/or minor hematoma(<2cms) requiring no treatment or hematoma requiring evacuation of blood clot) and infection (mild or superficial requiring no antibiotic treatment or moderately severe requiring antibiotic treatment).
5Downgraded because of imprecision (i.e. because of wide confidence intervals).
6Defined as sperm count <10,000/ml.
7Downgraded because of high loss to follow-up.
8The study did not measure unintended pregnancy rates.