Maruthappu Mahiben, Trehan Abhishek, Barnett-Vanes Ashton, McCulloch Peter, Carty Matthew J
Imperial College London, London, SW7 2AZ, UK,
World J Surg. 2015 Apr;39(4):879-89. doi: 10.1007/s00268-014-2897-0.
Increasing patient demands, costs and emphasis on safety have led to performance tracking of individual surgeons. Several methods of using these data, including feedback have been proposed. Our aim was to systematically review the impact of feedback of outcome data to surgeons on their performance.
MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews (from their inception to February 2013) were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. Forty two data-points per study were extracted.
The search strategy yielded 1,531 citations. Seven studies were eligible comprising 18,632 cases or procedures by 52 surgeons. Overall, feedback was found to be a powerful method for improving surgical outcomes or indicators of surgical performance, including reductions in hospital mortality after CABG of 24% (P = 0.001), decreases of stroke and mortality following carotid endarterectomy from 5.2 to 2.3%, improved ovarian cancer resection from 77 to 85% (P = 0.157) and reductions in wound infection rates from 14 to 10.3%. Improvements in performance occurred in concert with reduced costs: for hepaticojejunostomy, implementation of feedback was associated with a decrease in overall hospital costs from $24,446 to $20,240 (P < 0.01). Similarly, total cost of carotid endarterectomy and following management decreased from $13,344 to $9548.
The available literature suggests that feedback can improve surgical performance and outcomes; however, given the heterogeneity and limited number of studies, in addition to their non-randomised nature, it is difficult to draw clear conclusions from the literature with regard to the efficacy of feedback and the specific nuances required to optimise the impact of feedback. There is a clear need for more rigorous studies to determine how feedback of outcome data may impact performance, and whether this low-cost intervention has potential to benefit surgical practice.
患者需求增加、成本上升以及对安全性的重视导致了对个体外科医生的绩效跟踪。已经提出了几种使用这些数据的方法，包括反馈。我们的目的是系统评价向外科医生反馈结果数据对其绩效的影响。
检索了MEDLINE、Embase、PsycINFO、AMED以及Cochrane系统评价数据库（从建库至2013年2月）。两名评价者根据预先确定的纳入和排除标准独立评价文献。每项研究提取42个数据点。
检索策略共获得1531篇文献。7项研究符合纳入标准，涉及52名外科医生的18632例病例或手术。总体而言，发现反馈是改善手术结果或手术绩效指标的有效方法，包括冠状动脉旁路移植术后医院死亡率降低24%（P = 0.001），颈动脉内膜切除术后中风和死亡率从5.2%降至2.3%，卵巢癌切除术从77%提高到85%（P = 0.157），伤口感染率从14%降至l0.3%。绩效的改善伴随着成本的降低：对于肝空肠吻合术，实施反馈与医院总成本从24446美元降至20240美元相关（P < 0.01）。同样，颈动脉内膜切除术及其后续治疗的总成本从13344美元降至9548美元。
现有文献表明反馈可改善手术绩效和结果；然而，鉴于研究的异质性、数量有限以及非随机性质，很难从文献中就反馈的有效性以及优化反馈影响所需的具体细微差别得出明确结论。显然需要更严格的研究来确定结果数据反馈如何影响绩效，以及这种低成本干预措施是否有可能使外科实践受益。
