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Aim: This systematic review and meta‐analysis aimed to investigate the effect of preoperative stoma site marking on stoma‐related complications in patients with intestinal ostomy. Methods: MEDLINE, Embase, CENTRAL, CINHAL, and Google Scholar were searched up to August 2021 for randomised controlled trials (RCTs) and nonrandomised studies of interventions (NRSI) that involved patients with intestinal ostomies comparing preoperative stoma site marking to no marking and which reported at least one patient‐relevant outcome. Outcomes were prioritised by stakeholder involvement. Random‐effects meta‐analyses produced odds ratios (ORs) or standardised mean differences (SMD) and 95% confidence intervals (CIs). The ROBINS‐I tool and the GRADE approach were used to assess the risk of bias and certainty of evidence, respectively. Results: This review included two RCTs and 25 NRSI. The risk of bias was high in RCTs and serious to critical in NRSI. Although preoperative site marking reduced stoma‐related complications (OR: 0.45, 95% CI: [0.31–0.65]), dependence on professional or unprofessional care (narrative synthesis), and increased health‐related quality of life (SMD: 1.13 [0.38–1.88]), the evidence is very uncertain. Preoperative site marking may probably reduce leakage (OR: 0.14 [0.06–0.37]) and may decrease dermatological complications (OR: 0.38 [0.29–0.50]) and surgical revision (OR: 0.09 [0.02–0.49]). The confidence in the cumulative evidence was moderate to very low. Conclusion: Despite low quality evidence, preoperative stoma site marking can prevent stoma‐related complications and should be performed in patients undergoing gastrointestinal surgery given that this intervention poses no harm to patients. [ABSTRACT FROM AUTHOR]

Background: Data extraction forms link systematic reviews with primary research and provide the foundation for appraising, analysing, summarising and interpreting a body of evidence. This makes their development, pilot testing and use a crucial part of the systematic reviews process. Several studies have shown that data extraction errors are frequent in systematic reviews, especially regarding outcome data.Methods: We reviewed guidance on the development and pilot testing of data extraction forms and the data extraction process. We reviewed four types of sources: 1) methodological handbooks of systematic review organisations (SRO); 2) textbooks on conducting systematic reviews; 3) method documents from health technology assessment (HTA) agencies and 4) journal articles. HTA documents were retrieved in February 2019 and database searches conducted in December 2019. One author extracted the recommendations and a second author checked them for accuracy. Results are presented descriptively.Results: Our analysis includes recommendations from 25 documents: 4 SRO handbooks, 11 textbooks, 5 HTA method documents and 5 journal articles. Across these sources the most common recommendations on form development are to use customized or adapted standardised extraction forms (14/25); provide detailed instructions on their use (10/25); ensure clear and consistent coding and response options (9/25); plan in advance which data are needed (9/25); obtain additional data if required (8/25); and link multiple reports of the same study (8/25). The most frequent recommendations on piloting extractions forms are that forms should be piloted on a sample of studies (18/25); and that data extractors should be trained in the use of the forms (7/25). The most frequent recommendations on data extraction are that extraction should be conducted by at least two people (17/25); that independent parallel extraction should be used (11/25); and that procedures to resolve disagreements between data extractors should be in place (14/25).Conclusions: Overall, our results suggest a lack of comprehensiveness of recommendations. This may be particularly problematic for less experienced reviewers. Limitations of our method are the scoping nature of the review and that we did not analyse internal documents of health technology agencies. [ABSTRACT FROM AUTHOR]

Background: When conducting an Overviews of Reviews on health-related topics, it is unclear which combination of bibliographic databases authors should use for searching for SRs. Our goal was to determine which databases included the most systematic reviews and identify an optimal database combination for searching systematic reviews.Methods: A set of 86 Overviews of Reviews with 1219 included systematic reviews was extracted from a previous study. Inclusion of the systematic reviews was assessed in MEDLINE, CINAHL, Embase, Epistemonikos, PsycINFO, and TRIP. The mean inclusion rate (% of included systematic reviews) and corresponding 95% confidence interval were calculated for each database individually, as well as for combinations of MEDLINE with each other database and reference checking.Results: Inclusion of systematic reviews was higher in MEDLINE than in any other single database (mean inclusion rate 89.7%; 95% confidence interval [89.0-90.3%]). Combined with reference checking, this value increased to 93.7% [93.2-94.2%]. The best combination of two databases plus reference checking consisted of MEDLINE and Epistemonikos (99.2% [99.0-99.3%]). Stratification by Health Technology Assessment reports (97.7% [96.5-98.9%]) vs. Cochrane Overviews (100.0%) vs. non-Cochrane Overviews (99.3% [99.1-99.4%]) showed that inclusion was only slightly lower for Health Technology Assessment reports. However, MEDLINE, Epistemonikos, and reference checking remained the best combination. Among the 10/1219 systematic reviews not identified by this combination, five were published as websites rather than journals, two were included in CINAHL and Embase, and one was included in the database ERIC.Conclusions: MEDLINE and Epistemonikos, complemented by reference checking of included studies, is the best database combination to identify systematic reviews on health-related topics. [ABSTRACT FROM AUTHOR]

Background: It is important that systematic reviews (SRs) are up‐to‐date, otherwise they cannot be relied upon to guide decision‐making in practice and policy. Our aim was to investigate epidemiological, descriptive and reporting characteristics of a cross‐section of recently published updates of SRs. Methods: A SR update was defined as a new edition of a SR, either published by the same or new authors. We searched PubMed for SR updates published from January 01, 2016 to January 22, 2018 and included a random sample of n = 100 non‐Cochrane updates of SRs on interventions reported in English. Results: Most SR updates had a corresponding author from the United Kingdom, United States, or Canada (in total 48/100) and dealt with nonpharmacological interventions (63/100). The SR updates were published a median of 5 years (interquartile range [IQR] 3‐7) after the previous SR and included a median of 19 (IQR 9‐28) studies. 31/100 SR updates reported that the conclusion had changed since the previous version. Only 51/100 SR updates used the term "update" in the title and none reported having based the decision to update the previous SR on an existing method/decision tool. The number of newly included studies and participants and the number of studies and participants included in/from the previous SR were often not reported. Conclusions: The included non‐Cochrane updates were frequently missing important information that would be expected to be present in a SR update. Thus, structured and detailed reporting guidance specific to SR updates is needed. It should focus particularly on appropriate labeling and justification of updates, and how to incorporate information regarding the previous SR. [ABSTRACT FROM AUTHOR]

Background: Overviews of reviews (i.e., overviews) compile information from multiple systematic reviews to provide a single synthesis of relevant evidence for healthcare decision-making. Despite their increasing popularity, there are currently no systematically developed reporting guidelines for overviews. This is problematic because the reporting of published overviews varies considerably and is often substandard. Our objective is to use explicit, systematic, and transparent methods to develop an evidence-based and agreement-based reporting guideline for overviews of reviews of healthcare interventions (PRIOR, Preferred Reporting Items for Overviews of Reviews). Methods: We will develop the PRIOR reporting guideline in four stages, using established methods for developing reporting guidelines in health research. First, we will establish an international and multidisciplinary expert advisory board that will oversee the conduct of the project and provide methodological support. Second, we will use the results of comprehensive literature reviews to develop a list of prospective checklist items for the reporting guideline. Third, we will use a modified Delphi exercise to achieve a high level of expert agreement on the list of items to be included in the PRIOR reporting guideline. We will identify and recruit a group of up to 100 international experts who will provide input into the guideline in three Delphi rounds: the first two rounds will occur via online survey, and the third round will occur during a smaller (8 to 10 participants) in-person meeting that will use a nominal group technique. Fourth, we will produce and publish the PRIOR reporting guideline. Discussion: A systematically developed reporting guideline for overviews could help to improve the accuracy, completeness, and transparency of overviews. This, in turn, could help maximize the value and impact of overviews by allowing more efficient interpretation and use of their research findings. [ABSTRACT FROM AUTHOR]

Background: Stringent requirements exist regarding the transparency of the study selection process and the reliability of results. A 2-step selection process is generally recommended; this is conducted by 2 reviewers independently of each other (conventional double-screening). However, the approach is resource intensive, which can be a problem, as systematic reviews generally need to be completed within a defined period with a limited budget. The aim of the following methodological systematic review was to analyse the evidence available on whether single screening is equivalent to double screening in the screening process conducted in systematic reviews.Methods: We searched Medline, PubMed and the Cochrane Methodology Register (last search 10/2018). We also used supplementary search techniques and sources ("similar articles" function in PubMed, conference abstracts and reference lists). We included all evaluations comparing single with double screening. Data were summarized in a structured, narrative way.Results: The 4 evaluations included investigated a total of 23 single screenings (12 sets for screening involving 9 reviewers). The median proportion of missed studies was 5% (range 0 to 58%). The median proportion of missed studies was 3% for the 6 experienced reviewers (range: 0 to 21%) and 13% for the 3 reviewers with less experience (range: 0 to 58%). The impact of missing studies on the findings of meta-analyses had been reported in 2 evaluations for 7 single screenings including a total of 18,148 references. In 3 of these 7 single screenings - all conducted by the same reviewer (with less experience) - the findings would have changed substantially. The remaining 4 of these 7 screenings were conducted by experienced reviewers and the missing studies had no impact or a negligible on the findings of the meta-analyses.Conclusions: Single screening of the titles and abstracts of studies retrieved in bibliographic searches is not equivalent to double screening, as substantially more studies are missed. However, in our opinion such an approach could still represent an appropriate methodological shortcut in rapid reviews, as long as it is conducted by an experienced reviewer. Further research on single screening is required, for instance, regarding factors influencing the number of studies missed. [ABSTRACT FROM AUTHOR]

Background: The surgeon volume-outcome relationship has been discussed for many years and its existence or nonexistence is of importance for various reasons. A lot of empirical work has been published on it. We aimed to summarize systematic reviews in order to present current evidence. Methods: Medline, Embase, Cochrane database of systematic reviews (CDSR), and health technology assessment websites were searched up to October 2015 for systematic reviews on the surgeon volume-outcome relationship. Reviews were critically appraised, and results were extracted and synthesized by type of surgical procedure/ condition. Results: Thirty-two reviews reporting on 15 surgical procedures/conditions were included. Methodological quality of included systematic reviews assessed with the assessment of multiple systematic reviews (AMSTAR) was generally moderate to high albeit included literature partly neglected considering methodological issues specific to volumeoutcome relationship. Most reviews tend to support the presence of a surgeon volume-outcome relationship. This is most clear-cut in colorectal cancer, bariatric surgery, and breast cancer where reviews of high quality show large effects. Conclusions: When taking into account its limitations, this overview can serve as an informational basis for decision makers. Our results seem to support a positive volume-outcome relationship for most procedures/ conditions. However, forthcoming reviews should pay more attention to methodology specific to volume-outcome relationship. Due to the lack of information, any numerical recommendations for minimum volume thresholds are not possible. Further research is needed for this issue. [ABSTRACT FROM AUTHOR]

Background and Objective: Research collaborations in biomedical research have evolved over time. No studies have addressed research collaboration in network meta-analysis (NMA). In this study, we used social network analysis methods to characterize global collaboration patterns of published NMAs over the past decades. Methods: PubMed, EMBASE, Web of Science and the Cochrane Library were searched (at 9th July, 2015) to include systematic reviews incorporating NMA. Two reviewers independently selected studies and cross-checked the standardized data. Data was analyzed using Ucinet 6.0 and SPSS 17.0. NetDraw software was used to draw social networks. Results: 771 NMAs published in 336 journals from 3459 authors and 1258 institutions in 49 countries through the period 1997–2015 were included. More than three-quarters (n = 625; 81.06%) of the NMAs were published in the last 5-years. The BMJ (4.93%), Current Medical Research and Opinion (4.67%) and PLOS One (4.02%) were the journals that published the greatest number of NMAs. The UK and the USA (followed by Canada, China, the Netherlands, Italy and Germany) headed the absolute global productivity ranking in number of NMAs. The top 20 authors and institutions with the highest publication rates were identified. Overall, 43 clusters of authors (four major groups: one with 37 members, one with 12 members, one with 11 members and one with 10 members) and 21 clusters of institutions (two major groups: one with 62 members and one with 20 members) were identified. The most prolific authors were affiliated with academic institutions and private consulting firms. 181 consulting firms and pharmaceutical industries (14.39% of institutions) were involved in 199 NMAs (25.81% of total publications). Although there were increases in international and inter-institution collaborations, the research collaboration by authors, institutions and countries were still weak and most collaboration groups were small sizes. Conclusion: Scientific production on NMA is increasing worldwide with research leadership of Western countries (most notably, the UK, the USA and Canada). More authors, institutions and nations are becoming involved in research collaborations, but frequently with limited international collaborations. [ABSTRACT FROM AUTHOR]

Background and Objective: As systematic reviews may run out of date, it might be necessary to update them. Out-of-date reviews may jeopardize the comparability when used in the context of overviews (review of reviews). Methods: Seven electronic databases were searched for overviews up to November 2012. We first aimed to analyze whether the authors of overviews additionally searched for primary studies or alternatively explained why they did not. Second, we sought to analyze the actual publication lag (publication date of the overview--publication date of the review) in overviews and to develop recommendations for authors of overviews. Results: We included 147 overviews. The mean publication lag in overviews was more than 5 years. A median of 36% of the reviews were published more than 6 years ago. Only one in four reviews considered up-to-dateness. The methods for updating reviews were heterogeneous. We found no overview that systematically investigated whether an update was necessary. Conclusion: The issue of up-to-dateness when conducting overviews seems to be neglected by most authors of overviews. Authors should assess the quality of evidence, based on their included reviews first. [ABSTRACT FROM AUTHOR]

Background: The use of oral anticancer agents increased steadily in the last decades. Although oral anticancer agent adherence is important for a successful treatment, many patients are insufficiently adherent. Purpose: To evaluate adherence influencing factors in patients taking oral anticancer agents. Methods: A systematic literature search was performed in Medline and Embase. Titles and abstracts and in case of relevance, full-texts were screened according to predefined inclusion criteria. The risk of bias was assessed. Both were carried out independently by two reviewers. Relevant data on study characteristics and results were extracted in standardized tables by one reviewer and checked by a second. A meta-analysis was not performed because of clinical and methodological heterogeneity between the studies to avoid misleading results. Data were synthesized in narrative way using a standardized procedure. Results: Twenty-two relevant studies were identified. The study quality was moderate. Especially the risk of bias regarding the measurement of influencing factors and adherence was mostly unclear. Social support, intake of aromatase inhibitors, and lower out-of-pocket costs for OACA seem to have a positive effect on adherence. Depression and the number of different medications seem to have a negative effect on adherence. Low age and very high age seem to be associated with lower adherence. The remaining factors showed either mostly no influence or were heterogeneous regarding the effect direction and statistical significance. Conclusions: There are some factors that seem to have influence on adherence in patients taking OACA. However, due to the heterogeneity no general conclusions can be made also for these factors that can be applied to all indications, medications, settings, countries etc. The results should rather be considered as indications for factors that can have an influence on adherence to OACA. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this study was to determine if the authors mention overlapping reviews in overviews (reviews of reviews). In addition, we aimed to calculate the actual overlap in published overviews using newly introduced, validated measures. Study Design and Settings: We systematically searched for overviews from 2009 to 2011. Reviews included in the overviews were obtained. Tables (review × primary publication) were generated for each overview. The first occurrence of a primary publication is defined as the index publication. We calculated the ''corrected covered area'' (CCA) as a measure of overlap by dividing the frequency of repeated occurrences of the index publication in other reviews by the product of index publications and reviews, reduced by the number of index publications. Subgroup analyses were performed to investigate further differences in the overviews. Results: Only 32 of 60 overviews mentioned overlaps. The median CCA was 4.0. Validation of the CCA and other overlap measures was in accordance with our predefined hypotheses. The degree of overlap tended to be higher in health technology assessment reports than in journal publications and was higher with increasing numbers of publications. Conclusions: Overlaps must be reported in well-conducted overviews, and this can comprehensively be accomplished using the CCA method. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine published overviews of systematic reviews in terms of descriptive and methodological characteristics. Study Design and Setting: MEDLINE, Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, and several Health Technology Assessment databases were searched for overviews of reviews up to February 2012. We extracted data from the methods and results sections of the included overviews. These data were analyzed descriptively as frequencies or medians and interquartile ranges. Results: We included 126 overviews of reviews. According to our sample, publication rates for overviews have risen in the last decade. The quality of the included reviews was systematically appraised in 64% of the overviews. The most commonly used assessment tools were the Overview Quality Assessment Questionnaire (26%), Assessment of Multiple Systematic Reviews (11%), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (5%). Only three of 18 overviews restricted to Cochrane reviews in our sample performed a quality assessment. Strategies to deal with discordant reviews were reported in 5% of the overviews. Searches for additional primary studies were conducted in 5% of the overviews. Conclusion: Overviews of reviews often lack methodological rigor. Methodological standards and reporting guidelines for overviews are needed to improve the quality of this new publication type. [Copyright &y& Elsevier]

Background: Gastroschisis is a congenital anomaly that needs surgical management for repositioning intestines into the abdominal cavity and for abdominal closure. Higher hospital or surgeon volume has previously been found to be associated with better clinical outcomes for different especially high-risk, low volume procedures. Therefore, we aim to examine the relationship between hospital or surgeon volume and outcomes for gastroschisis. Methods: We will perform a systematic literature search from inception onwards in Medline, Embase, CENTRAL, CINAHL, and Biosis Previews without applying any limitations. In addition, we will search trial registries and relevant conference proceedings. We will include (cluster-) randomized controlled trials (RCTs) and prospective or retrospective cohort studies analyzing the relationship between hospital or surgeon volume and clinical outcomes. The primary outcomes will be survival and mortality. Secondary outcomes will be different measures of morbidity (e.g., severe gastrointestinal complications, gastrointestinal dysfunctions, and sepsis), quality of life, and length of stay. We will systematically assess risk of bias of included studies using RoB 2 for individually or cluster-randomized trials and ROBINS-I for cohort studies, and extract data on the study design, patient characteristics, case-mix adjustments, statistical methods, hospital and surgeon volume, and outcomes into standardized tables. Title and abstract screening, full text screening, critical appraisal, and data extraction of results will be conducted by two reviewers independently. Other data will be extracted by one reviewer and checked for accuracy by a second one. Any disagreements will be resolved by discussion. We will not pool results statistically as we expect included studies to be clinically and methodologically very diverse. We will conduct a systematic synthesis without meta-analysis and use GRADE for assessing the certainty of the evidence. Discussion: Given the lack of a comprehensive summary of findings on the relationship between hospital or surgeon volume and outcomes for gastroschisis, this systematic review will put things right. Results can be used to inform decision makers or clinicians and to adapt medical care. Systematic review registration: Open Science Framework (DOI: 10.17605/OSF.IO/EX34M; 10.17605/OSF.IO/HGPZ2) [ABSTRACT FROM AUTHOR]

Background: A standard or consensus definition of a systematic review does not exist. Therefore, if there is no definition about a systematic review in secondary studies that analyse them or the definition is too broad, inappropriate studies might be included in such evidence synthesis. The aim of this study was to analyse the definition of a systematic review (SR) in health care literature, elements of the definitions that are used and to propose a starting point for an explicit and non-ambiguous SR definition.Methods: We included overviews of systematic reviews (OSRs), meta-epidemiological studies and epidemiology textbooks. We extracted the definitions of SRs, as well as the inclusion and exclusion criteria that could indicate which definition of a SR the authors used. We extracted individual elements of SR definitions, categorised and quantified them.Results: Among the 535 analysed sources of information, 188 (35%) provided a definition of a SR. The most commonly used reference points for the definitions of SRs were Cochrane and the PRISMA statement. We found 188 different elements of SR definitions and divided them into 14 categories. The highest number of SR definition elements was found in categories related to searching (N = 51), analysis/synthesis (N = 23), overall methods (N = 22), quality/bias/appraisal/validity (N = 22) and aim/question (N = 13). The same five categories were also the most commonly used combination of categories in the SR definitions.Conclusion: Currently used definitions of SRs are vague and ambiguous, often using terms such as clear, explicit and systematic, without further elaboration. In this manuscript we propose a more specific definition of a systematic review, with the ultimate aim of motivating the research community to establish a clear and unambiguous definition of this type of research. [ABSTRACT FROM AUTHOR]

Results of medical tests are the main source to inform clinical decision making. The main information to assess the usefulness of medical tests for correct discrimination of patients are accuracy measures. For the estimation of test accuracy measures, many different study designs can be used. The study design is related to the clinical question to be answered (diagnosis, prognosis, prediction), determines the accuracy measures that can be calculated and it might have an influence on risk of bias. Therefore, a clear and consistent distinction of the different study designs in systematic reviews on test accuracy studies is very important. In this paper, we propose an algorithm for the classification of study designs of test accuracy, that compare the results of an index test (the test to be evaluated) with the results of a reference test (the test whose results are considered as correct/the gold standard) studies in systematic reviews. [ABSTRACT FROM AUTHOR]

Background: Previous meta-analyses have found several advantages of icodextrin compared with glucose in the application of peritoneal dialysis (PD), such as an improvement of peritoneal ultrafiltration during the long dwell and a reduction in episodes of uncontrolled fluid overload. However, the effect of icodextrin on patient-relevant outcomes remains unclear. This review aims to evaluate the benefits and harms of icodextrin in comparison with conventional glucose PD solution in patients with end-stage kidney disease receiving PD. Methods: Randomized controlled trials of icodextrin comparing with conventional glucose solution in patients with end-stage kidney disease who received PD will be deemed eligible. We will conduct systematic searches in MEDLINE, EMBASE, CENTRAL, Ichushi-Web, Chinese and Japanese databases, and in clinical trials registries (ClinicalTrials.gov, International Clinical Trials Registry Platform Search Portal (ICTRP), EU Clinical Trials Register, Japan Registries Network (JPRN), China's Clinical Trial Registry (ChiCTR)). Furthermore, we will check conference proceedings and search references from relevant studies manually. Relevant pharmaceutical companies, authors, and experts will be contacted in an effort to identify further studies. We will not apply any limitations regarding language, publication status, and publication date when searching for eligible studies. The selection of studies, data extraction, and risk of bias assessment will be carried out by two independent reviewers. Data synthesis will be performed using RevMan 5 software with either a fixed effects model or random-effects model, depending on the presence of heterogeneity. For the assessment of statistical heterogeneity, I2 will be calculated. Sources of clinical heterogeneity will be evaluated through subgroup analyses. If there are ten or more studies included in the meta-analysis, we will investigate the publication bias using funnel plots and Egger's test. The quality of the body of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Discussion: We assume that our systematic review will be more comprehensive compared to those published previously due to contacting the relevant pharmaceutical companies and a systematic search of published and unpublished non-English studies from China, Taiwan, and Japan. Systematic review registration: PROSPERO CRD42018096951 [ABSTRACT FROM AUTHOR]

Background: Financial rewards have been shown to be an important motivator to include normal healthy volunteers in trials. Less emphasis has been put on non-healthy volunteers. No previous study has investigated the impact of a voucher incentive for participants in a cross-sectional study in a clinical setting. The objective of this study was to examine the impact of a small voucher incentive on a survey response rate in a clinical setting at the point-of-care in a quasi-randomized controlled trial (q-RCT).Methods: This was an ancillary study to a survey of patients subsequent to their appointment with a physician investigating physician-patient communication. We randomized participants to receive or not receive a voucher for a coffee (costs: 1 €) enclosed in the survey package. Alternation of groups was performed on a weekly basis. The exact Chi-square test was used to compare response rates between study arms.Results: In total, 472 participants received the survey package. Among them, 249 participants were quasi-randomized to the voucher arm and 223 to the control group. The total response rate was 46%. The response rates were 48% in the voucher arm and 44% in the control group. The corresponding risk ratio was 1.09 (95% CI: 0.89, 1.32).Conclusions: A small voucher incentive to increase the response rate in a survey investigating physician-patient communication was unlikely to have an impact. It can be speculated whether the magnitude of the voucher was too low to generate an impact. This should be further investigated in future real-world studies. [ABSTRACT FROM AUTHOR]

Background: The rate of caesarean sections increased in the last decades to about 30% of births in western populations. Many caesarean sections are electively planned without an urgent medical reason for mother or child. Especially in women with a foregoing caesarean section, the procedure is planned early. An early caesarean section though may harm the newborn. Our aim is to evaluate the gestational time point after the 37th gestational week (after prematurity = term) of performing an elective caesarean section with the lowest morbidity for mother and child. Methods: This is an update of a systematic review previously carried out on behalf of the German Federal Ministry of Health. We will perform a systematic literature search in MEDLINE, EMBASE, CENTRAL and CINAHL. Our primary outcome is the rate of admissions to the neonatal intensive care unit in early versus late term neonates. We will include (quasi) randomized controlled trials and cohort studies. The studies should include pregnant women who have an elective caesarean section at term. We will screen titles and abstracts and the identified full texts of studies for eligibility. Risk of bias will be assessed with the Cochrane Risk of Bias Tool for Randomized Trials or with the Risk of Bias Tool for Non-Randomized Studies of Interventions (ROBINS-I). These tasks will be performed independently by two reviewers. Data will be extracted in beforehand piloted extraction tables. A dose-response meta-analysis will be performed. Discussion: Our aim is to reach a higher validity in the assessment of the time point of elective caesarean sections by performing a meta-analysis to support recommendations for clinical practice. We assume to identify less randomized controlled trials but a large number of cohort studies analyzing the given question. We will discuss similarities and differences in included studies as well as methodological strengths and weaknesses. Systematic review registration: PROSPERO CRD42017078231 [ABSTRACT FROM AUTHOR]