Department of Surgery, Aga Khan University Medical College, Karachi, Sindh, Pakistan.
Department of Surgery, University of Wisconsin, Madison, Wisconsin.
J Surg Res. 2023 Oct;290:188-196. doi: 10.1016/j.jss.2023.04.017. Epub 2023 Jun 1.
Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical outcomes data from low- and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings.
We conducted a scoping review of all published literature on barriers to conducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and GoogleScholar. Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors.
Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital platform for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors highlighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time.
There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.
系统地收集和分析手术结果数据是外科质量改进的基石。不幸的是，来自中低收入国家（LMICs）的手术结果数据仍然匮乏。为了改善 LMICs 的外科手术结果，必须具备收集、分析和报告风险调整后术后发病率和死亡率数据的能力。本研究旨在回顾在 LMIC 环境中开发围手术期登记处面临的障碍和挑战。
我们使用 PubMed、Embase、Scopus 和 Google Scholar 对所有关于在 LMIC 进行外科手术结果研究的障碍的已发表文献进行了范围综述。关键词包括“手术”、“结果研究”、“登记处”、“障碍”和同义词医学主题词衍生词。随后对找到的文章进行了参考文献挖掘。所有相关的原始研究和 2000 年至 2021 年期间发表的综述都包括在内。使用常规信息系统管理框架来组织确定的障碍，将其分为技术、组织或行为因素。
我们的搜索共确定了 12 篇文章。其中 10 篇文章专门针对创伤登记处的创建、成功和实施过程中面临的障碍进行了研究。50%的文章报道了技术因素，包括进入数据录入数字平台的机会有限、表格缺乏标准化以及表格复杂。91.7%的文章提到了组织因素，包括资源可用性、财务限制、人力资源和缺乏一致的电力。66.6%的研究强调了行为因素，包括缺乏团队承诺、工作限制和临床负担，这些因素导致合规性差，数据收集随时间减少。
关于在 LMICs 开发和维护围手术期登记处的障碍，发表的文献很少。现在迫切需要研究和了解在 LMICs 持续收集外科手术结果的障碍和促进因素。
