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, Gutenbergstraße 13, 10587, Berlin, Germany.
Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, Building 38, 51109, Cologne, Germany; Institute for Medical Statistics, University Medical Center Goettingen, Humboldtallee 32, 37073, Göttingen, Germany.
J Pediatr Surg. 2022 Dec;57(12):763-785. doi: 10.1016/j.jpedsurg.2022.03.022. Epub 2022 Mar 28.
Newborns with gastroschisis need surgery to reduce intestines into the abdominal cavity and to close the abdominal wall. Due to an existing volume-outcome relationship for other high-risk, low-volume procedures, we aimed at examining the relationship between hospital or surgeon volume and outcomes for gastroschisis.
We conducted a systematic literature search in Medline, Embase, CENTRAL, CINAHL and Biosis Previews in June 2021 and searched for additional literature. We included (cluster-) randomized controlled trials (RCTs) and prospective or retrospective cohort studies analyzing the relationship between hospital or surgeon volume and mortality, morbidity or quality of life. We assessed risk of bias of included studies using ROBINS-I and performed a systematic synthesis without meta-analysis and used GRADE for assessing the certainty of the evidence.
We included 12 cohort studies on hospital volume. Higher hospital volume may reduce in-hospital mortality of neonates with gastroschisis, while the evidence is very uncertain for other outcomes. Findings are based on a low certainty of the evidence for in-hospital mortality and a very low certainty of the evidence for all other analyzed outcomes, mainly due to risk of bias and imprecision. We did not identify any study on surgeon volume.
The evidence suggests that higher hospital volume reduces in-hospital mortality of newborns with gastroschisis. However, the magnitude of this effect seems to be heterogeneous and results should be interpreted with caution. There is no evidence on the relationship between surgeon volume and outcomes.
患有先天性腹壁裂的新生儿需要进行手术，将肠道纳入腹腔并关闭腹壁。由于其他高风险、低容量手术存在量效关系，我们旨在研究医院或外科医生的手术量与先天性腹壁裂手术结果之间的关系。
我们于 2021 年 6 月在 Medline、Embase、CENTRAL、CINAHL 和 Biosis Previews 中进行了系统文献检索，并搜索了其他文献。我们纳入了（簇）随机对照试验（RCT）和前瞻性或回顾性队列研究，分析了医院或外科医生手术量与死亡率、发病率或生活质量之间的关系。我们使用 ROBINS-I 评估纳入研究的偏倚风险，并进行了系统综合分析而不进行荟萃分析，并使用 GRADE 评估证据的确定性。
我们纳入了 12 项关于医院手术量的队列研究。较高的医院手术量可能降低患有先天性腹壁裂的新生儿的院内死亡率，而其他结果的证据非常不确定。这些发现的证据确定性为低，主要是由于存在偏倚和不准确性，对于院内死亡率的证据确定性为低，对于所有其他分析结果的证据确定性为非常低。我们没有发现任何关于外科医生手术量的研究。
证据表明，较高的医院手术量可降低患有先天性腹壁裂的新生儿的院内死亡率。然而，这种效果的幅度似乎存在异质性，结果应谨慎解释。目前没有关于外科医生手术量与结果之间关系的证据。
