目的:系统回顾急性手术单位(ASU)模型的比较研究。
方法:对Cochrane进行了搜索,Embase,Medline和灰色文学。符合条件的文章是发表于01/01/2000-12/03/2020的急性外科手术单元(ASU)模型的比较研究。在有任何诊断的患者中,主要结果是住院时间,下班后运行,并发症和费用。次要结果是手术时间审查,时间到剧院,任何诊断的患者的死亡率和再次入院,胆道疾病患者入院时进行胆囊切除术。计划对特定队列进行其他分析,如阑尾炎或胆囊炎患者。
结果:搜索返回了9,677个结果,从中确定了77个合格出版物,代表150,981名独特患者。对于除成本外的所有结果的荟萃分析,队列都是充分同质的。对于有任何诊断的患者,与传统模式相比,ASU模型的引入与住院时间缩短相关(平均差[MD]0.68天;95%置信区间[CI]0.38-0.98),下班后手术率(比值比[OR]0.56;95%CI0.46-0.69)和并发症(OR0.48,95%CI0.33-0.70).关于成本,两项研究报告了ASU引入后的节省,虽然没有发现任何区别。在次要结果中,对于任何诊断的患者,ASU开始与手术检查时间减少有关,剧院和死亡的时间。重新录取保持不变。对于胆道疾病患者,ASU的建立与索引胆囊切除术的高利率相关。
结论:与传统结构相比,ASU模型对于大多数指标都是优越的。应在政策中促进ASU的引入,以实现广泛利益。
OBJECTIVE: To systematically review comparative studies on the acute surgical unit (ASU) model.
METHODS: Searches were performed of Cochrane, Embase, Medline and grey literature. Eligible articles were comparative studies of the Acute Surgical Unit (ASU) model published 01/01/2000-12/03/2020. Amongst patients with any diagnosis, primary outcomes were length of stay, after-hours operating, complications and cost. Secondary outcomes were time to surgical review, time to theatre, mortality and re-admission for patients with any diagnosis, and cholecystectomy during index admission for patients with biliary disease. Additional analyses were planned for specific cohorts, such as patients with appendicitis or cholecystitis.
RESULTS: Searches returned 9,677 results from which 77 eligible publications were identified, representing 150,981 unique patients. Cohorts were adequately homogenous for meta-analysis of all outcomes except cost. For patients with any diagnosis, compared with the Traditional model, the introduction of an ASU model was associated with reduced length of stay (mean difference [MD] 0.68 days; 95% confidence interval [CI] 0.38-0.98), after-hours operating rates (odds ratio [OR] 0.56; 95% CI 0.46-0.69) and complications (OR 0.48, 95% CI 0.33-0.70). Regarding cost, two studies reported savings following ASU introduction, while one found no difference. Amongst secondary outcomes, for patients with any diagnosis, ASU commencement was associated with reduced time to surgical review, time to theatre and mortality. Re-admissions were unchanged. For patients with biliary disease, ASU establishment was associated with superior rates of index cholecystectomy.
CONCLUSIONS: Compared to the Traditional structure, the ASU model is superior for most metrics. ASU introduction should be promoted in policy for widespread benefit.