Martinez-Nicolas Ismael, Arnal-Velasco Daniel, Romero-García Eva, Fabregas Neus, Sanduende Otero Yolanda, Leon Irene, Bartakke Ashish A, Silva-Garcia Javier, Rodriguez Anna, Valli Claudia, Zamarian Sandro, Zaludek Adam, Meneses-Echavez Jose, Loaiza-Betancur Andrés F, Sousa Paulo, Orrego Carola, Soria-Aledo Victor
Spanish Anaesthesia and Reanimation Incident Reporting System (SENSAR), Alcorcon, Spain.
Department of Anaesthesia and Reanimation, Hospital Universitario Fundación Alcorcon, Alcorcon, Spain.
BJS Open. 2024 Oct 29;8(6). doi: 10.1093/bjsopen/zrae143.
Surgical-related incidents are a common cause of in-hospital adverse events. Surgical patient safety would benefit from evidence-based practices, but a comprehensive collection of patient safety recommendations is still lacking. This study aimed to compile and assess the perioperative patient safety recommendations for adults.
A systematic review of clinical practice guidelines was conducted using Medline, Embase, Cochrane, Virtual Health Library Regional Portal, and Trip Database from 2012 to 2022. Eligibility criteria followed a PICAR strategy for patient safety recommendations in the perioperative care continuum. Guidelines were appraised for quality, particularly focusing on the 'rigour of development' domain of the AGREE-II tool for those containing strong recommendations. Descriptive analyses were conducted, emphasizing guideline quality, recommendation strength, and the supporting level of evidence.
From the 267 guidelines, 4666 perioperative patient safety recommendations were extracted, of which 44.9% (2095) were strongly recommended. Of these, 322 had the highest level of evidence, but only 18 guidelines met high standards in the AGREE-II 'rigour of development' domain. A subset of 78 recommendations ranked the highest in the strength of recommendation, level of evidence, and rigour of development of their guidelines. A gap was found within pre-admission and post-discharge care recommendations.
This review highlights the noteworthy variability in the methodological quality of the guidelines, and a discordance between strength of recommendation and evidence level of the available perioperative patient safety recommendations. These findings provide valuable information for advising policy decisions and promoting best practices to enhance global surgical safety.
PROSPERO (CRD42022347449).
手术相关事件是医院内不良事件的常见原因。基于循证实践将有利于手术患者的安全，但目前仍缺乏全面收集的患者安全建议。本研究旨在汇编和评估针对成人围手术期患者安全的建议。
使用Medline、Embase、Cochrane、虚拟健康图书馆区域门户和Trip数据库，对2012年至2022年的临床实践指南进行系统综述。纳入标准遵循围手术期护理连续过程中患者安全建议的PICAR策略。对指南进行质量评估，对于包含强烈建议的指南，特别关注AGREE-II工具的“制定严谨性”领域。进行描述性分析，重点关注指南质量、建议强度和证据支持水平。
从267份指南中提取了4666条围手术期患者安全建议，其中44.9%（2095条）为强烈建议。其中，322条有最高级别的证据，但只有18份指南在AGREE-II“制定严谨性”领域达到高标准。78条建议在其指南的建议强度、证据水平和制定严谨性方面排名最高。在入院前和出院后护理建议方面存在差距。
本综述强调了指南方法学质量的显著差异，以及现有围手术期患者安全建议的建议强度与证据水平之间的不一致。这些发现为指导政策决策和推广最佳实践以提高全球手术安全性提供了有价值的信息。
PROSPERO（CRD42022347449）
