在结直肠外科手术中使用教科书结果评估质量改善:系统性审查
Luis Hurtado-Pardo1, Zutoia Balciscueta Coltell1, Janine Tabet Almeida1
1Department of General and Digestive Surgery, Colorectal Unit, Arnau de Vilanova Hospital, Valencia, Spain.
Cirugia espanola
|October 12, 2025
概括
在结直肠外科手术中定义教科书结果对于理想的外科护理至关重要. 这项研究突出了定义的变化,并提出了一种统一测量手术成功的共识.
科学领域:
- 结肠直肠手术 结肠直肠手术
- 外科手术的结果
- 医疗保健质量指标 医疗保健质量指标
背景情况:
- 教科书的结果是理想的外科手术后期护理的综合测量.
- 对于结直肠外科手术的教科书结果缺乏标准化的定义,这阻碍了一致的评估.
- 定义的变化会影响对手术质量和患者结果的评估.
研究的目的:
- 系统地审查和总结在结直肠外科手术中教科书成果的现有定义.
- 识别当前定义中的共同组成部分和差异.
- 为本外科领域的教科书成果提出共识定义.
主要方法:
- 按照PRISMA指导方针进行系统的文献审查,至2025年4月.
- 包括对成人患者进行结肠或直肠切除的初级研究,以评估教科书结果.
- 对21项的分析包括了综合定义和确定关键变量的研究.
主要成果:
- 实现的教科书成果在各个研究中范围广泛,从41.8%到80.8%.
- "没有死亡率"和"逗留时间"是最常被纳入的变量 (85.7%).
- "没有并发症"是不符合教科书结果标准的最常见原因 (42.9%),有六种不同的定义.
结论:
- 在结直肠外科手术中,教科书结局的定义存在显著的变化.
- 需要一个共识定义来标准化测量和提高这种质量指标的实用性.
- 一个拟议的定义包括没有并发症 (Clavien-Dindo>III),优化住院时间,30天内没有再入院/死亡率,以及瘤切除 (R0,>12个淋巴结).
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