Tables and figures are in a separate document available via the BMJ website at http://www.bmj.com, and available here converted to PDF.Objective: To assess the effect of publication bias on the results and conclusions of systematic reviews and\ud meta-analyses.\ud \ud Design: Analysis of published meta-analyses by trim and fill method.\ud \ud Studies: 48 reviews in Cochrane Database of\ud Systematic Reviews that considered a binary endpoint and contained 10 or more individual studies.\ud \ud Main outcome measures: Number of reviews with missing studies and effect on conclusions of meta-analyses.\ud \ud Results: The trim and fill fixed effects analysis method estimated that 26 (54%) of reviews had missing studies and in 10 the number missing was significant. The\ud corresponding figures with a random effects model were 23 (48%) and eight. In four cases, statistical inferences regarding the effect of the intervention were changed after the overall estimate for publication bias was adjusted for.\ud \ud Conclusions: Publication or related biases were common within the sample of metaanalyses assessed. In most cases these biases did not affect the conclusions. Nevertheless, researchers should check\ud routinely whether conclusions of systematic reviews are robust to possible nonrandom selection mechanisms
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