背景:术后疼痛控制不佳对康复有负面影响,并且是持续术后疼痛发展的关键风险因素。这项范围审查的目的是确定住院非心脏手术患者在家中康复时在疼痛管理方面的医疗服务差距。
方法:由PubMed的医学图书馆员进行搜索,MEDLINE,EMBASE,EBSCOCINAHL,WebofScience,和Cochrane数据库对2016年至2022年发表的文章的系统评论。纳入标准为成年人(≥18岁),英语语言,住院非心脏手术,包括在家庭康复后的前3个月内,手术后急性和/或持续性疼痛管理的护理至少有一个差距。两名审稿人独立筛选文章的收录和提取数据。使用主题分析综合了每篇与护理差距相关的文章的报价。
结果:来自数据库和灰色文献的4794个结果,其中38条符合纳入标准。从这些,提取了23个缺口,涵盖医疗保健提供的所有六个领域(容量,组织结构,金融,病人,护理流程和基础设施,和文化)。确定的差距被合成为五个总体主题:教育(22项研究),提供连续性护理(21项研究),个性化管理(10项研究),对特定人群的支持(11项研究),以及研究和知识翻译(10项研究)。
结论:这项范围审查确定了术后疼痛管理的关键时期的健康分娩差距。这些差距代表了质量改进和未来研究的潜在目标,以改善围手术期护理和以患者为中心的长期结局。
■开放科学框架(https://osf.io/cq5m6/)。
Poor pain control during the postoperative period has negative implications for recovery, and is a critical risk factor for development of persistent postsurgical pain. The aim of this scoping review is to identify gaps in healthcare delivery that patients undergoing inpatient noncardiac surgeries experience in pain management while recovering at home.
Searches were conducted by a medical librarian in PubMed, MEDLINE, EMBASE, EBSCO CINAHL, Web of Science, and Cochrane Database of Systematic Reviews for articles published between 2016 and 2022. Inclusion criteria were adults (≥18 yr), English language, inpatient noncardiac surgery, and included at least one gap in care for acute and/or persistent pain management after surgery within the first 3 months of recovery at home. Two reviewers independently screened articles for inclusion and extracted data. Quotations from each article related to gaps in care were synthesised using thematic analysis.
There were 4794 results from databases and grey literature, of which 38 articles met inclusion criteria. From these, 23 gaps were extracted, encompassing all six domains of healthcare delivery (capacity, organisational structure, finances, patients, care processes and infrastructure, and culture). Identified gaps were synthesised into five overarching themes: education (22 studies), provision of continuity of care (21 studies), individualised management (10 studies), support for specific populations (11 studies), and research and knowledge translation (10 studies).
This scoping review identified health delivery gaps during a critical period in postoperative pain management. These gaps represent potential targets for quality improvement and future research to improve perioperative care and longer-term patient-centred outcomes.
Open Science Framework (https://osf.io/cq5m6/).