Ribeiro Tiago, Malhotra Armaan K, Bondzi-Simpson Adom, Eskander Antoine, Ahmadi Negar, Wright Frances C, McIsaac Daniel I, Mahar Alyson, Jerath Angela, Coburn Natalie, Hallet Julie
Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Br J Surg. 2024 Nov 27;111(12). doi: 10.1093/bjs/znae278.
Days at home after surgery is a promising new patient-centred outcome metric that measures time spent outside of healthcare institutions and mortality. The aim of this scoping review was to synthesize the use of days at home in perioperative research and evaluate how it has been termed, defined, and validated, with a view to inform future use.
The search was run on MEDLINE, Embase, and Scopus on 30 March 2023 to capture all perioperative research where days at home or equivalent was measured. Days at home was defined as any outcome where time spent outside of hospitals and/or healthcare institutions was calculated.
A total of 78 articles were included. Days at home has been increasingly used, with most studies published in 2022 (35, 45%). Days at home has been applied in multiple study design types, with varying terminology applied. There is variability in how days at home has been defined, with variation in measures of healthcare utilization incorporated across studies. Poor reporting was noted, with 14 studies (18%) not defining how days at home was operationalized and 18 studies (23%) not reporting how death was handled. Construct and criterion validity were demonstrated across seven validation studies in different surgical populations.
Days at home after surgery is a robust, flexible, and validated outcome measure that is being increasingly used as a patient-centred metric after surgery. With growing use, there is also growing variability in terms used, definitions applied, and reporting standards. This review summarizes these findings to work towards coordinating and standardizing the use of days at home after surgery as a patient-centred policy and research tool.
术后在家天数是一个很有前景的以患者为中心的新结局指标，用于衡量在医疗机构之外度过的时间以及死亡率。本范围综述的目的是综合围手术期研究中术后在家天数的使用情况，并评估其如何被命名、定义和验证，以便为未来的使用提供参考。
于2023年3月30日在MEDLINE、Embase和Scopus数据库进行检索，以获取所有测量术后在家天数或等效指标的围手术期研究。术后在家天数被定义为计算在医院和/或医疗机构之外度过的时间的任何结局指标。
共纳入78篇文章。术后在家天数的使用越来越多，大多数研究发表于2022年（35篇，45%）。术后在家天数已应用于多种研究设计类型，使用了不同的术语。术后在家天数的定义存在差异，各研究纳入的医疗保健利用指标也有所不同。研究报告质量较差，14项研究（18%）未定义术后在家天数的操作方法，18项研究（23%）未报告如何处理死亡情况。在针对不同手术人群的7项验证研究中证明了结构效度和标准效度。
术后在家天数是一种可靠、灵活且经过验证的结局指标，越来越多地被用作术后以患者为中心的指标。随着使用的增加，在使用的术语、应用的定义和报告标准方面也存在越来越大的差异。本综述总结了这些发现，以努力协调和规范术后在家天数作为以患者为中心的政策和研究工具的使用。
