PDF(Pubmed)
Abstract：
The global shortage of skilled anaesthesiologists, surgeons and obstetricians is a leading cause of high unmet surgical need. Although anaesthetic and surgical task-shifting are widely practised to mitigate this barrier, little is known about their safety and efficacy. This systematic review seeks to highlight the existing evidence on the clinical outcomes of patients operated on by non-physicians or non-specialist physicians globally. Relevant articles were identified by searching four databases (MEDLINE, EMBASE, CINAHL and Global Health) in all languages between January 2008 and February 2022. Retrieved documents were screened against pre-specified inclusion and exclusion criteria, and their qualities were appraised critically. Data were extracted by two independent reviewers and findings were synthesized narratively. In total, 40 studies have been included. Thirty-five focus on task-shifting for surgical and obstetric procedures, whereas four studies address anaesthetic task-shifting; one study covers both interventions. The majority are located in sub-Saharan Africa and the USA. Seventy-five per cent present perioperative mortality outcomes and 85% analyse morbidity measures. Evidence from low- and middle-income countries, which primarily concentrates on caesarean sections, hernia repairs and surgical male circumcisions, points to the overall safety of non-surgeons. On the other hand, the literature on surgical task-shifting in high-income countries (HICs) is limited to nine studies analysing tube thoracostomies, neurosurgical procedures, caesarean sections, male circumcisions and basal cell carcinoma excisions. Finally, only five studies pertaining to anaesthetic task-shifting across all country settings answer the research question with conflicting results, making it difficult to draw conclusions on the quality of non-physician anaesthetic care. Overall, it appears that non-specialists can safely perform high-volume, low-complexity operations. Further research is needed to understand the implications of surgical task-shifting in HICs and to better assess the performance of non-specialist anaesthesia providers. Future studies must adopt randomized study designs and include long-term outcome measures to generate high-quality evidence.
摘要：
全球缺乏熟练的麻醉师，外科医生和产科医生是高未满足手术需求的主要原因。尽管广泛采用麻醉和手术任务转移来减轻这种障碍，对它们的安全性和有效性知之甚少。本系统综述旨在强调全球非医师或非专科医师手术患者临床结局的现有证据。通过搜索四个数据库(MEDLINE，EMBASE,CINAHL和全球卫生）在2008年1月至2022年2月之间使用所有语言。检索到的文件根据预先指定的纳入和排除标准进行筛选，他们的素质得到了严格的评价。数据由两名独立的审稿人提取，结果以叙述方式合成。总的来说,共纳入40项研究。三十五个重点是外科和产科手术的任务转移，而四项研究涉及麻醉任务转移;一项研究涵盖了两项干预措施。大多数位于撒哈拉以南非洲和美国。75%的人表示围手术期死亡率结果，85%的人分析发病率指标。来自低收入和中等收入国家的证据，主要集中在剖腹产上，疝修补术和外科男性包皮环切术，指出非外科医生的整体安全性。另一方面,关于高收入国家（HIC）外科任务转移的文献仅限于九项分析管状胸廓造口术的研究，神经外科手术,剖腹产,男性包皮环切术和基底细胞癌切除术。最后,只有五项与所有国家/地区的麻醉任务转移有关的研究以相互矛盾的结果回答了研究问题，使得很难得出非医师麻醉护理质量的结论。总的来说,看来非专业人员可以安全地执行大批量，低复杂度操作。需要进一步的研究来了解手术任务转移对HIC的影响，并更好地评估非专科麻醉提供者的表现。未来的研究必须采用随机研究设计，并包括长期结果测量，以产生高质量的证据。
