术后进行心脏手术是否会影响术后的结果? 一个系统的审查和元分析
Andrew O'Connell1, Ryaan El-Andari1, Nicholas M Fialka1
1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AL, Canada.
The Journal of cardiovascular surgery
|October 9, 2024
概括
在工作时间以外进行的心脏手术的安全性与工作时间内进行的手术相似,死亡率或重大并发症没有显著差异. 在工作时间之外,部伤口感染的发生率略高. 需要进一步的研究来证实这些发现.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 患者安全 患者安全
背景情况:
- 由于睡眠剥夺和资源限制等潜在因素,人们对非工作时间内进行的心脏手术的安全性存在担忧.
- 现有的关于非工作时间心脏手术结果的文献提出了不一致的发现.
- 这项研究系统地审查和元分析数据,比较工作时间内心脏手术与工作时间外心脏手术.
研究的目的:
- 为了比较经过心脏手术的患者在工作时间和工作时间以外的周围手术结果.
- 根据心脏手术干预的时间确定死亡率和发病率的任何显著差异.
- 综合当前关于非工作时间心脏手术安全性的证据.
主要方法:
- 在PubMed和Embase上对2000年1月至2023年9月期间发表的研究进行了系统的文献搜索.
- 包括比较心脏手术在上班时间和下班时间的结果的研究.
- 从3540个手稿标题和摘要的初步选中,选出了11篇文章.
主要成果:
- 综合分析显示,在住院死亡率 (OR1.04;P=0.93) 或术后发病率 (包括中风,重新手术,重大出血和并发症) 中没有统计学意义上的差异.
- 在接受上班手术的患者中,胸部伤口感染的复合率显著更高 (P=0.01).
- 除了一个异常研究外,住院死亡率和重新手术率偏好了上班时间的手术.
结论:
- 总的来说,外科手术期间的发病率和死亡率似乎在很大程度上相当于在上班时间和下班时间进行的心脏手术.
- 诸如手术人员疲劳,患者手术前风险,临床环境和资源限制等因素可能导致结果异质.
- 需要进一步的研究来直接比较在工作时间和工作时间之外出现的心脏手术,控制基线风险,以澄清时间对术后结果的影响.
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