低、中、高收入国家围手术期死亡率：多水平荟萃回归分析方案。
Perioperative mortality in low-, middle-, and high-income countries: Protocol for a multi-level meta-regression analysis.
机构信息
Department of Epidemiology & Biostatistics, Western University, London, Ontario, Canada.
Department of Anesthesia & Perioperative Medicine, Centre for Medical Evidence Decision Integrity Clinical Impact (MEDICI), Western University, London, Ontario, Canada.
出版信息
PLoS One. 2024 Nov 1;19(11):e0288888. doi: 10.1371/journal.pone.0288888. eCollection 2024.
BACKGROUND
Surgery is an indispensable component of a functional healthcare system. To date there is limited information regarding how many people die during the perioperative period globally. This study describes a protocol for a systematic review and multilevel meta-regression to evaluate time trends regarding the odds of perioperative mortality among adults undergoing a bellwether surgical procedure while accounting for higher order clustering at the national level.
METHODS
Published studies reporting the number of perioperative deaths from bellwether surgical procedures among adults will be identified from MEDLINE, Embase, Cochrane CENTRAL, LILACS and Global Index Medicus. The primary outcome will be the rate of perioperative mortality across time and the secondary outcome will be investigating cause of death over time as a proportion of overall perioperative mortality. Two reviewers will independently conduct full text screening and extract the data. Disagreements will first be resolved via consensus. If consensus cannot be reached a third reviewer will be included to arbitrate. Due to human resource limitations, a risk of bias appraisal will not be conducted. From the included studies a multilevel meta-regression will be constructed to synthesize the results. This model will conceptualize patients as nested in studies which are in turn nested within countries while taking into account potential confounding variables at all levels.
DISCUSSION
The systematic review and multilevel meta-regression that will be conducted based on this protocol will provide synthesized global evidence regarding the trends of perioperative mortality. This eventual study may help policymakers and other key stakeholders with benchmarking surgical safety initiatives as well as identify key gaps in our current understanding of global perioperative mortality.
TRIAL REGISTRATION
Systematic review registration: PROSPERO registration number 429040.
背景
手术是功能健全的医疗体系中不可或缺的一环。截至目前，全球围手术期死亡人数的相关信息有限。本研究描述了一项系统评价和多层次荟萃回归分析方案，以评估成人接受标志性手术期间围手术期死亡率的时间趋势，同时考虑国家层面的高级别聚类。
方法
将从 MEDLINE、Embase、Cochrane 中心、LILACS 和全球医学索引中检索报告成人标志性手术围手术期死亡人数的已发表研究。主要结局指标是随时间变化的围手术期死亡率，次要结局指标是随时间推移调查死因占总围手术期死亡率的比例。两名评审员将独立进行全文筛选和提取数据。如果存在分歧，首先将通过协商解决。如果无法达成共识，将纳入第三名评审员进行仲裁。由于人力资源有限，不会进行偏倚风险评估。从纳入的研究中，将构建一个多层次的荟萃回归模型来综合结果。该模型将患者视为嵌套在研究中的个体，而研究又嵌套在国家中，同时考虑所有层面的潜在混杂变量。
讨论
基于本方案进行的系统评价和多层次荟萃回归将提供关于围手术期死亡率趋势的全球综合证据。这项最终研究可能有助于政策制定者和其他利益攸关方对手术安全举措进行基准测试，并确定我们对全球围手术期死亡率的现有理解中的关键差距。
试验注册
系统评价注册：PROSPERO 注册号 429040。
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