Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Can J Anaesth. 2019 Sep;66(9):1095-1105. doi: 10.1007/s12630-019-01433-5. Epub 2019 Jul 9.
Collaborative ("shared-care") models of postoperative care improve outcomes in patients undergoing surgery for hip fracture. Despite being widely adopted, it is unclear if similar benefits of shared-care models exist for other at-risk surgical patient populations. Thus, we performed a systematic review to understand the impact of shared-care models.
EMBASE, MEDLINE, CINAHL, and Cochrane Central Register databases were searched for prospective studies examining an in-hospital shared-care approach to postoperative management of adult non-cardiac surgery patients. The primary outcome was a composite of in-hospital mortality and mortality of up to 30 days. Secondary outcomes were long-term mortality (> 90 days) and hospital length of stay. Tertiary outcomes included quality of life and health utility measures. Risk of bias was assessed using Cochrane Collaboration tools.
Six thousand eight hundred and ninety-six citations were reviewed and four studies (n = 987 patients) met the inclusion criteria-two randomized-controlled trials (RCT, n = 729 patients) and two non-randomized-controlled trials (NRCT, n = 258 patients). All studies were conducted in the elective surgical setting. There was no association between shared-care and control groups for in-hospital mortality (Peto odds ratio, 1.76; 95% confidence interval [CI], 0.65 to 4.80), or hospital length of stay (mean difference, -1.41; 95% CI, -3.18 to 0.35). Reporting of other outcomes was limited. Both RCTs were judged to be at high risk of bias for blinding and both NRCTs were judged to be at moderate risk of bias for reported outcomes.
Overall, there was limited high-quality evidence to evaluate the effect of postoperative shared-care. Well-designed interventional studies, perhaps targeting higher risk surgical populations, are needed.
PROSPERO (CRD42018094943); registered 16 May, 2018.
协作式（“共享护理”）术后护理模式可改善髋部骨折手术患者的治疗效果。尽管这种模式已被广泛采用，但对于其他高危手术患者群体，共享护理模式是否具有类似的益处尚不清楚。因此，我们进行了一项系统评价，以了解共享护理模式的影响。
检索了 EMBASE、MEDLINE、CINAHL 和 Cochrane 中心注册数据库，以寻找评估成人非心脏手术患者住院期间共享护理方法对术后管理影响的前瞻性研究。主要结局是院内死亡率和 30 天内死亡率的综合指标。次要结局是长期死亡率（>90 天）和住院时间。三级结局包括生活质量和健康效用测量。使用 Cochrane 协作工具评估偏倚风险。
共审查了 6896 条引文，有 4 项研究（n=987 名患者）符合纳入标准——2 项随机对照试验（RCT，n=729 名患者）和 2 项非随机对照试验（NRCT，n=258 名患者）。所有研究均在择期手术环境中进行。共享护理组和对照组之间在院内死亡率（Peto 比值比，1.76；95%置信区间[CI]，0.65 至 4.80）或住院时间（平均差值，-1.41；95%CI，-3.18 至 0.35）方面均无关联。其他结局的报告有限。2 项 RCT 均因盲法而被评为高度偏倚风险，2 项 NRCT 均因报告结局而被评为中度偏倚风险。
总体而言，评估术后共享护理效果的高质量证据有限。需要设计良好的干预性研究，也许可以针对风险更高的手术人群。
PROSPERO（CRD42018094943）；2018 年 5 月 16 日注册。
