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[JAMA Netw Open发表论文]:数字健康干预措施与腹腔手术患者安全
2024年06月16日 时讯速递, 进展交流 [JAMA Netw Open发表论文]:数字健康干预措施与腹腔手术患者安全已关闭评论

Original Investigation 

Statistics and Research Methods

April 26, 2024

Digital Health Interventions and Patient Safety in Abdominal Surgery: A Systematic Review and Meta-Analysis

Artem Grygorian, Diego Montano, Mahdieh Shojaa, et al

JAMA Netw Open. 2024;7(4):e248555. doi:10.1001/jamanetworkopen.2024.8555

Key Points

Question  Can perioperative telemedicine reduce the incidence of adverse events in abdominal surgery?

Findings  In this systematic review and meta-analysis of 19 randomized trials and nonrandomized studies with 10 536 patients, significant reduction in readmission rates and emergency department visits was found with telemedicine interventions compared with conventional care after abdominal surgery. There was no difference in complication rates between patients in telehealth and conventional care groups.

Meaning  Findings of this study suggest that perioperative telemedicine may play a role in reduced incidence of readmissions and emergency department visits after abdominal surgery; however, further research is needed to elucidate specific mechanisms of action.

Abstract

Importance  Over the past 2 decades, several digital technology applications have been used to improve clinical outcomes after abdominal surgery. The extent to which these telemedicine interventions are associated with improved patient safety outcomes has not been assessed in systematic and meta-analytic reviews.

Objective  To estimate the implications of telemedicine interventions for complication and readmission rates in a population of patients with abdominal surgery.

Data Sources  PubMed, Cochrane Library, and Web of Science databases were queried to identify relevant randomized clinical trials (RCTs) and nonrandomized studies published from inception through February 2023 that compared perioperative telemedicine interventions with conventional care and reported at least 1 patient safety outcome.

Study Selection  Two reviewers independently screened the titles and abstracts to exclude irrelevant studies as well as assessed the full-text articles for eligibility. After exclusions, 11 RCTs and 8 cohort studies were included in the systematic review and meta-analysis and 7 were included in the narrative review.

Data Extraction and Synthesis  Data were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline and assessed for risk of bias by 2 reviewers. Meta-analytic estimates were obtained in random-effects models.

Main Outcomes and Measures  Number of complications, emergency department (ED) visits, and readmissions.

Results  A total of 19 studies (11 RCTs and 8 cohort studies) with 10 536 patients were included. The pooled risk ratio (RR) estimates associated with ED visits (RR, 0.78; 95% CI, 0.65-0.94) and readmissions (RR, 0.67; 95% CI, 0.58-0.78) favored the telemedicine group. There was no significant difference in the risk of complications between patients in the telemedicine and conventional care groups (RR, 1.05; 95% CI, 0.77-1.43).

Conclusions and Relevance  Findings of this systematic review and meta-analysis suggest that perioperative telehealth interventions are associated with reduced risk of readmissions and ED visits after abdominal surgery. However, the mechanisms of action for specific types of abdominal surgery are still largely unknown and warrant further research.

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