Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany.
Medical Consultancy Department, Federal Joint Committee, Wegelystraße 8, 10623, Berlin, Germany.
Syst Rev. 2018 Nov 13;7(1):185. doi: 10.1186/s13643-018-0872-9.
Congenital diaphragmatic hernia is a rare and life-threatening anomaly that occurs during fetal development and results in an incomplete or incorrect formation of the diaphragm. Surgical therapy of the diaphragm should be performed after clinical stabilization of the neonate. 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 congenital diaphragmatic hernia.
This systematic review protocol has been designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol. We will perform a systematic literature search in MEDLINE, Embase, CINAHL and Biosis Previews without applying any limitations. In addition, we will search for relevant conference abstracts. We will screen titles and abstracts of retrieved studies, obtain potentially relevant full texts, and assess the eligibility of those full texts against our inclusion criteria. We will include comparative studies analyzing the relationship between hospital or surgeon volume and clinical outcomes. We will systematically assess risk of bias of included 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 perform a meta-analysis as we expect included studies to be clinically and methodologically very diverse. We will synthesize findings from primary studies in a structured narrative way and using GRADE.
Given the lack of a comprehensive summary of findings on the relationship between hospital or surgeon volume and outcomes for congenital diaphragmatic hernia, this systematic review will put things right. Results can be used to inform decision makers or clinicians and to adapt medical care.
PROSPERO ( CRD42018090231 ).
先天性膈疝是一种罕见且危及生命的异常，发生在胎儿发育过程中，导致膈不完全或不正确形成。新生儿临床稳定后应进行膈疝的外科治疗。先前发现，较高的医院或外科医生手术量与不同的特别是高风险、低容量手术的更好的临床结果相关。因此，我们旨在研究医院或外科医生手术量与先天性膈疝结局之间的关系。
本系统评价方案是根据系统评价和荟萃分析报告的首选项目设计的。我们将在 MEDLINE、Embase、CINAHL 和 Biosis Previews 中进行系统文献检索，不应用任何限制。此外，我们将搜索相关会议摘要。我们将筛选检索研究的标题和摘要，获取潜在相关的全文，并根据纳入标准评估这些全文的合格性。我们将纳入分析医院或外科医生手术量与临床结局之间关系的比较研究。我们将系统评估纳入研究的偏倚风险，并将研究设计、患者特征、病例组合调整、统计方法、医院和外科医生手术量以及结局等数据纳入标准化表格。标题和摘要筛选、全文筛选、批判性评价和结果数据提取将由两名评审员独立进行。其他数据将由一名评审员提取，并由另一名评审员检查准确性。任何分歧将通过讨论解决。由于预计纳入研究在临床和方法学上非常多样化，我们将不进行荟萃分析。我们将以结构化叙述的方式综合主要研究的发现，并使用 GRADE。
鉴于缺乏关于医院或外科医生手术量与先天性膈疝结局之间关系的全面综合结果，本系统评价将纠正这一问题。结果可用于为决策者或临床医生提供信息，并调整医疗保健。
PROSPERO（CRD42018090231）。
