Department of Surgical Affairs, Royal College of Surgeons of Ireland, 121 St. Stephen's Green, Dublin 2, Ireland.
Healthcare Outcomes Research Centre, Royal College of Surgeons of Ireland, Beaux Lane House, Mercer Street Lower, Dublin 2, Ireland.
Surgeon. 2020 Apr;18(2):80-90. doi: 10.1016/j.surge.2019.06.003. Epub 2019 Jul 22.
Emergency abdominal surgery is associated with poorer clinical outcomes than similar procedures in the elective setting. Research into emergency laparotomy (EL) care is moving from observational studies which simply measure EL outcomes to interventional research evaluating the implementation of care strategies designed to improve the quality and outcomes from EL care. There is no consensus as to the optimal approach to conducting research in this sphere. The primary objective of this review was to examine how mortality and other outcome measures were reported in previous EL research and to identify what might be the most appropriate methods in future outcome research.
A systematic review was performed in accordance with the PRISMA principles. Electronic databases were interrogated with a pre-specified search strategy to identify English language studies addressing outcomes from EL care. Retrieved papers were screened and assessed according to pre-defined eligibility criteria. The mortality and other outcomes reported in each paper were extracted and examined.
16 studies were included. They demonstrated significant heterogeneity in case definition, outcome reporting and data processing. A wide range of mortality and other outcome measures were applied and reported. Only few studies included on patient-reported outcomes measures.
The heterogeneity in EL research, demonstrated by this review must be considered when EL outcomes are compared. A standardized approach with respect to case definition, outcome measurement, and data analysis would provide for more valid and comparable evaluation of EL outcomes. Future EL research should include more patient centred outcomes.
与择期手术相比，急诊腹部手术的临床结局较差。针对急诊剖腹手术（EL）护理的研究已从单纯测量 EL 结果的观察性研究转向评估旨在提高 EL 护理质量和结果的护理策略实施的干预性研究。在这一领域开展研究的最佳方法尚未达成共识。本综述的主要目的是检查既往 EL 研究中死亡率和其他结局指标的报告情况，并确定未来结局研究中可能最合适的方法。
根据 PRISMA 原则进行系统综述。使用预先指定的搜索策略对电子数据库进行查询，以确定探讨 EL 护理结局的英文研究。对检索到的论文进行筛选，并根据预先确定的纳入标准进行评估。提取并检查每份论文报告的死亡率和其他结局。
纳入了 16 项研究。它们在病例定义、结局报告和数据处理方面表现出显著的异质性。应用和报告了广泛的死亡率和其他结局指标。只有少数研究包括患者报告的结局指标。
本综述表明，EL 研究中的异质性在比较 EL 结局时必须加以考虑。在病例定义、结局测量和数据分析方面采用标准化方法将为更有效地评估 EL 结局提供更可靠和可比的依据。未来的 EL 研究应包括更多以患者为中心的结局。
