Abstract：
BACKGROUND: Newborns with gastroschisis need surgery to reduce intestines into the abdominal cavity and to close the abdominal wall. Due to an existing volume-outcome relationship for other high-risk, low-volume procedures, we aimed at examining the relationship between hospital or surgeon volume and outcomes for gastroschisis.
METHODS: We conducted a systematic literature search in Medline, Embase, CENTRAL, CINAHL and Biosis Previews in June 2021 and searched for additional literature. We included (cluster-) randomized controlled trials (RCTs) and prospective or retrospective cohort studies analyzing the relationship between hospital or surgeon volume and mortality, morbidity or quality of life. We assessed risk of bias of included studies using ROBINS-I and performed a systematic synthesis without meta-analysis and used GRADE for assessing the certainty of the evidence.
RESULTS: We included 12 cohort studies on hospital volume. Higher hospital volume may reduce in-hospital mortality of neonates with gastroschisis, while the evidence is very uncertain for other outcomes. Findings are based on a low certainty of the evidence for in-hospital mortality and a very low certainty of the evidence for all other analyzed outcomes, mainly due to risk of bias and imprecision. We did not identify any study on surgeon volume.
CONCLUSIONS: The evidence suggests that higher hospital volume reduces in-hospital mortality of newborns with gastroschisis. However, the magnitude of this effect seems to be heterogeneous and results should be interpreted with caution. There is no evidence on the relationship between surgeon volume and outcomes.
METHODS: We conducted a systematic literature search in Medline, Embase, CENTRAL, CINAHL and Biosis Previews in June 2021 and searched for additional literature. We included (cluster-) randomized controlled trials (RCTs) and prospective or retrospective cohort studies analyzing the relationship between hospital or surgeon volume and mortality, morbidity or quality of life. We assessed risk of bias of included studies using ROBINS-I and performed a systematic synthesis without meta-analysis and used GRADE for assessing the certainty of the evidence.
RESULTS: We included 12 cohort studies on hospital volume. Higher hospital volume may reduce in-hospital mortality of neonates with gastroschisis, while the evidence is very uncertain for other outcomes. Findings are based on a low certainty of the evidence for in-hospital mortality and a very low certainty of the evidence for all other analyzed outcomes, mainly due to risk of bias and imprecision. We did not identify any study on surgeon volume.
CONCLUSIONS: The evidence suggests that higher hospital volume reduces in-hospital mortality of newborns with gastroschisis. However, the magnitude of this effect seems to be heterogeneous and results should be interpreted with caution. There is no evidence on the relationship between surgeon volume and outcomes.
摘要：
背景：患有腹裂的新生儿需要手术以减少肠道进入腹腔并关闭腹壁。由于其他高风险的现有数量-结果关系，小批量程序，我们的目的是研究医院或外科医生的容量与胃裂结局之间的关系.
方法：我们在Medline进行了系统的文献检索，Embase,中部,2021年6月CINAHL和Biosis预览，并搜索更多文献。我们纳入（集群）随机对照试验（RCTs）和前瞻性或回顾性队列研究，分析医院或外科医生数量与死亡率之间的关系。发病率或生活质量。我们使用ROBINS-I评估纳入研究的偏倚风险，并在没有荟萃分析的情况下进行系统综合，并使用GRADE评估证据的确定性。
结果：我们纳入了12项关于医院数量的队列研究。更高的医院容量可能会降低腹裂新生儿的院内死亡率。而其他结果的证据非常不确定。调查结果基于住院死亡率证据的低确定性和所有其他分析结果证据的低确定性。主要是由于偏见和不精确的风险。我们没有发现任何关于外科医生体积的研究。
结论：证据表明，更高的住院量可降低腹裂新生儿的住院死亡率。然而,这种效应的大小似乎是不均匀的,应谨慎解释结果.没有证据表明外科医生体积和结果之间的关系。
方法：我们在Medline进行了系统的文献检索，Embase,中部,2021年6月CINAHL和Biosis预览，并搜索更多文献。我们纳入（集群）随机对照试验（RCTs）和前瞻性或回顾性队列研究，分析医院或外科医生数量与死亡率之间的关系。发病率或生活质量。我们使用ROBINS-I评估纳入研究的偏倚风险，并在没有荟萃分析的情况下进行系统综合，并使用GRADE评估证据的确定性。
结果：我们纳入了12项关于医院数量的队列研究。更高的医院容量可能会降低腹裂新生儿的院内死亡率。而其他结果的证据非常不确定。调查结果基于住院死亡率证据的低确定性和所有其他分析结果证据的低确定性。主要是由于偏见和不精确的风险。我们没有发现任何关于外科医生体积的研究。
结论：证据表明，更高的住院量可降低腹裂新生儿的住院死亡率。然而,这种效应的大小似乎是不均匀的,应谨慎解释结果.没有证据表明外科医生体积和结果之间的关系。
