背景:截至2022年,患者遵守术后指南可以将腹腔镜腹部手术后的并发症风险降低高达52.4%。随着各种术前教育干预措施(POEI)的可用性,了解哪些POEI可以改善整个程序的患者预后。
目的:本研究旨在通过系统回顾文献中报道的所有POEI来确定哪种POEI对患者预后最有效。
方法:总共,4753篇调查各种POEI的文章(例如,视频,介绍,移动应用程序,和一对一的教育或辅导)是从PubMed收集的,Embase,和Scopus数据库。纳入标准为接受腹部腹腔镜手术的成年患者,随机对照试验,以及提供术后结果的研究。排除标准包括未以英文发表且无结果报告的研究。标题和摘要及全文文章与POEI随机对照研究是基于上述标准通过盲法筛选,使用Covidence(Veritas健康创新)进行双重审查。通过Cochrane偏差风险工具评估研究质量。对收录的文章进行了教育内容分析,干预时机,干预类型,和适合特定手术的术后结果。
结果:只有17项研究符合我们的标准,1831例患者接受腹腔镜胆囊切除术,减肥手术(胃旁路和胃袖),还有结肠切除术.总的来说,15项研究报告了至少1名患者术后结果的统计学显着改善。根据Cochrane标准,这些研究均未发现总体偏倚风险较高。总的来说,41%(7/17)的纳入研究使用直接个人教育改善了几乎所有手术类型的结果,虽然教育视频对焦虑的影响最大,恶心,术后疼痛(P<0.01)。直接团体教育显示体重显着改善,BMI,锻炼,33%(2/6)的腹腔镜胃旁路术研究中出现抑郁症状。
结论:直接教育(以个人或团体为基础)对术后腹腔镜手术结局有积极影响。
背景:PROSPEROCRD42023438698;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=438698。
BACKGROUND: As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative.
OBJECTIVE: This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature.
METHODS: In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery.
RESULTS: Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies.
CONCLUSIONS: Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes.
BACKGROUND: PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.