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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 12  |  Issue : 5  |  Page : 76-78

Does hospital-based transitional care reduce the postoperative complication in patients with enterostomy? A meta-analysis


1 Department of Operation Room, Lishui Central Hospital, The 5th Affiliated Hospital of Wenzhou Medical University, Lishui 323000, PR China
2 Department of General Surgery, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000, PR China
3 Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000, PR China

Date of Web Publication7-Oct-2016

Correspondence Address:
Xuemei Zhu
Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000
PR China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.191637

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 > Abstract 


Objective: The objective of the study is to investigate whether hospital-based transitional care can reduce the postoperative complication in patients who received enterostomy or not by pooling the published prospective clinical studies.
Materials and Methods: Prospective clinical studies related to hospital-based transitional care for reducing the postoperative complication in patients with enterostomy were searched in the electronic databases of PubMed, Medline, EMBASE, CNKI, and Wanfang. The postoperative complications in the experiment and control groups were extracted from the original studies and pooled by fixed effects model. The publication bias was evaluated by Begg's funnel plot and Egger's line regression test.
Results: After searching through the electronic databases of PubMed, Medline, EMBASE, CNKI, and Wanfang, we finally included in eight studies with 600 cases related to hospital-based transitional care and postoperative complication in patients with enterostomy. The pooled result showed that hospital-based transitional care could significantly reduce the postoperative complication in patients with enterostomy (risk ratio = 0.42, 95% confidence interval: 1.0.32, ~0.55, P = 0.005) by fixed effects model. The Begg's funnel plot demonstrated a litter left-right asymmetry, which indicated potential publication bias. Moreover, Egger's line regression test showed that there were significant publications (t = −3.04, P = 0.023).
Conclusion: Hospital-based transitional care can significantly reduce the postoperative complication in patients with enterostomy.

Keywords: Enterostomy, hospital-based transitional care, meta-analysis, postoperative complication


How to cite this article:
Chen Y, Jiang J, Wu Y, Yan J, Chen H, Zhu X. Does hospital-based transitional care reduce the postoperative complication in patients with enterostomy? A meta-analysis. J Can Res Ther 2016;12:76-8

How to cite this URL:
Chen Y, Jiang J, Wu Y, Yan J, Chen H, Zhu X. Does hospital-based transitional care reduce the postoperative complication in patients with enterostomy? A meta-analysis. J Can Res Ther [serial online] 2016 [cited 2018 May 22];12:76-8. Available from: http://www.cancerjournal.net/text.asp?2016/12/5/76/191637




 > Introduction Top


Due to the limitation of social public health resources, health service in the less-developed regions is limited, which cannot provide enough service for discharged patients. Thereafter, there is still a certain gap between nursing requirement and health service provider in discharged patients.[1],[2] Hence, the hospital-based transitional care is important for this situation. Recently, several studies reported the clinical effects of hospital-based transitional care for reducing the postoperative complication in patients with enterostomy.[3],[4] However, the conclusion was not completely consistent for small sample size of the published studies. Hence, we searched the open-published clinical trials about hospital-based transitional care for reducing the postoperative complication in patients with enterostomy and pooling the data to further evaluate its clinical efficacy by meta-analysis method.


 > Materials and Methods Top


Studies searching

Prospective clinical studies related to hospital-based transitional care can reduce the postoperative complication in patients with enterostomy were searched in the electronic databases of PubMed, Medline, EMBASE, CNKI, and Wanfang. We use the following text word to find the potentially suitable studies. The searching terms were stoma/intestinalstoma/enterostomy/cecostomy/colostomy/duodenostomy/ileostomy/jejunostomy, continuing care/transitional care, visiting nurse, follow-up, ostomy clinic/outpatient, patient club. The title and abstract of the first identified studies were primary evaluated to assess whether it was appropriate to the inclusion criteria or not. Then, all the potentially relevant trials were evaluated in full-text paper, and all references of included articles were further scanned for additional inclusion.

Inclusion and exclusion criteria

The inclusion criteria were (1) the study design was prospective clinical trials; (2) the patients were treated with enterostomy; (3) the intervention was transitional care in the experiment group and routine discharge guidance in the control group; (4) the results were postoperative complication incidence rate. The exclusion criteria were (1) patients not received enterostomy or <18 years old; (2) case report or review; (3) not enough data to pool the combined risk ratio (RR); (4) duplicate publications.

Data extraction

The data of the included eight studies were extracted by two reviewers (Chen Yi and Jiang Jinyan) independently. The disagreement was resolved by discussion or consulted to the third reviewer. The following information and data were extracted from the original included eight studies: first author and corresponding author name, year of paper published, number of patients included in each study, and treatment arms and the outcomes data of postoperative complication incidence rate in each study.

Statistical method

The dichotomous data are expressed by n and the postoperative complication risk was demonstrated by RR and its 95% confidence interval (95% CI). We first evaluated the statistical heterogeneity among the included studies by Chi-square test,[5] and the inconsistency was calculated by I2.[6] If Chi-square (P < 0.05 or I2 > 50%, the random effects method was used to pool the data with statistical heterogeneity. Otherwise, fixed effects method was used with no statistical heterogeneity. The Egger's line regression tests and Begg's funnel plot were used to assess the publication bias.[7] All the data were analyzed by Stata11.0 software (http://www.stata.com; Stata Corporation, College Station, TX).


 > Results Top


Detailed information of included studies

After searching the electronic databases of PubMed, Medline, EMBASE, CNKI, and Wanfang, we finally included 8 studies with 600 cases related to hospital-based transitional care and postoperative complication in patients with enterostomy. Seven of the included studies were published in Chinese and indexed in CNKI or Wanfang databases, and one was published in English and indexed in PubMed. Patients in the control group were given routine discharge guidance or health education, and patients in the experiment group were given transitional care including (a) telephone follow-up; (b) home follow-up; (c) outpatient visits; (e) association; and (g) special lecture. The detailed information for the included eight studies is demonstrated in [Table 1].
Table 1: The detailed information for the included eight studies

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Statistical heterogeneity assess

The statistical heterogeneity was evaluated by Chi-square test. We found that there was no statistical heterogeneity for effect size of RR (I2 = 25.9%, P = 0.22). Hence, the data were pooled by fixed effects model.

Meta-analysis

Without significant statistical heterogeneity, the data were pooled by fixed effects model. The combined result showed that hospital-based transitional care can significantly reduce the postoperative complication in patients with enterostomy [RR = 0.42, 95% CI: 1.0.32, ~0.55, P = 0.005, [Figure 1].
Figure 1: The Forest plot of transitional care for reducing the postoperative complication in patients with enterostomy

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Publication bias investigation

The publication bias was evaluated by Begg's funnel plot and Egger's line regression test.[5] The Begg's funnel plot demonstrated a litter left-right asymmetry, which indicated potential publication bias. Moreover, Egger's line regression test showed that there was significant publications [t = −3.04, P = 0.023, [Figure 2].
Figure 2: The Begg's funnel plot in evaluation of publication bias for effect size of risk ratio

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 > Discussion Top


The aim of transitional care is to reduce the secondary hospitalization rate, save medical costs, and improve the quality of life, which can meet the needs of discharged patients.[12] Several published studies have investigated hospital-based transitional care for reducing the postoperative complication in patients with enterostomy.[3],[8] However, the conclusion was not entirely consistent. Zhang et al.[11] performed a prospective, randomized controlled trials to evaluate effects of enterostomal nurse telephone follow-up on the postoperative adjustment of discharged colostomy patients. In their study, they recruited 103 cases who have undergone enterostomy and randomly divided into experiment and control groups. Patients in the control group received routine discharge care, and patients in the experiment group received 2–3 nurse telephone calls during the follow-up period with hospital-based transitional care. They found that patients in the experiment group had significantly better ostomy adjustment, higher stoma self-efficacy, higher satisfaction with care, and less stoma complications compared with control group. The results indicated that hospital-based transitional care could reduce the postoperative complication and improve the quality of life in patients with enterostomy. However, Ying [8] found that the positive complication rate was 17.3% and 40.4% for the experiment and control groups, respectively, without significant statistical difference.

In this study, we searched the electronic databases and included eight prospective clinical studies related to hospital-based transitional care for reducing the postoperative complication in patients with enterostomy. We found that the statistical heterogeneity was not statistically significant, so the data were pooled with fixed effects model. The pooled data indicated that the hospital-based transitional care can significantly reduce the postoperative complication in patients with enterostomy (RR = 0.42, 95% CI: 1.0.32, ~0.55, P = 0.005) by fixed effects model. However, significant publication bias was existed in this meta-analysis according to Begg's funnel plot and Egger's line regression test (t = −3.04, P = 0.023). We believe that hospital-based transitional care can significantly reduce the postoperative complication in patients with enterostomy. However, for the drawbacks of small number cases included in this meta-analysis and significant publication bias, more well-designed, prospective, randomized controlled trials needed for further evaluation the clinical efficacy of hospital-based transitional care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Xiu-Hui G. Impact of continual nursing intervention on quality of life of patients undergoing colostomy. J Anhui Health Vocat Tech Coll 2014;13:85-6.  Back to cited text no. 1
    
2.
Wu Ling GG, Wang Gui LL. Study on influence of health education on quality of life of patients with rectal carcinoma after colostomy. Mod Nurs 2008;14:425-7.  Back to cited text no. 2
    
3.
Shuluan C. Home care for 44 patients with intestinal stoma. J Qilu Nur 2011;8:324-6.  Back to cited text no. 3
    
4.
Weiqin C, Hequn W, Liyun W, Weihong Y. The effect of transitional care in patients received permanent colon stoma. Pract Clin Med 2012;13:115-6.  Back to cited text no. 4
    
5.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.  Back to cited text no. 5
[PUBMED]    
6.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.  Back to cited text no. 6
    
7.
Song F, Gilbody S. Bias in meta-analysis detected by a simple, graphical test. Increase in studies of publication bias coincided with increasing use of meta-analysis. BMJ 1998;316:471.  Back to cited text no. 7
[PUBMED]    
8.
Ying L. Study on the Effect of Discharged Nursing Guidance for Prevention of the Complications of Colon Stoma. Vol. 26. The Eighth National Conference on Stoma, Wound and Incontinence Nursing in China; 2011. p. 114-5.  Back to cited text no. 8
    
9.
Wang Fei ZP, Li Gubing HY. Effect of community-based nursing intervention on self-care ability in patients with colostomy. Shanghai Nurs 2014;14:8-11.  Back to cited text no. 9
    
10.
Yun B, Juying Z. Application of We Chat follow-up in patients with intestinal stoma. Chin J Rural Med Pharm 2014;21:66-7.  Back to cited text no. 10
    
11.
Zhang JE, Wong FK, You LM, Zheng MC, Li Q, Zhang BY, et al. Effects of enterostomal nurse telephone follow-up on postoperative adjustment of discharged colostomy patients. Cancer Nurs 2013;36:419-28.  Back to cited text no. 11
[PUBMED]    
12.
Kreuzer M, Prüfe J, Oldhafer M, Bethe D, Dierks ML, Müther S, et al. Transitional care and adherence of adolescents and young adults after kidney transplantation in Germany and Austria: A binational observatory census within the TRANSNephro trial. Medicine (Baltimore) 2015;94:e2196.  Back to cited text no. 12
    


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