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Year : 2014  |  Volume : 10  |  Issue : 1  |  Page : 180-186

Effects of clinical pathways used in surgery for uterine fibroids: A meta-analysis

1 School of Public Health; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
2 Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
3 School of Public Health, Lanzhou University, Lanzhou 730000, China
4 Women and Children Hospital of Lanzhou City, Lanzhou 730000, China

Correspondence Address:
Zhang Peizhen
No.74 Wu Quan West Road, Chengguan District, Lanzhou-730 000, Gansu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.131460

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Background: Whether clinical pathways (CPWs) used in surgery for uterine fibroids have positive effects or not remains unclear. Aims: To assess the implementation effectsof CPW sin surgery for uterine fibroids. Materials and Methods: Eight databases were searched comprehensively from inception to November 2012, which including the Cochrane Library, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database, etc. Two reviewers selected studies, assessed risk of bias, and extracted data of included studies independently. Jadad methodological approach was applied to assess the quality of included studies and meta-analysis was conducted by RevMan 5.1 software. Results: Ten studies involving 775 patients were included. The aggregate overall results showed that a shorter average length of stay (mean difference (MD) = -1.61; 95% CI (-1.91, -1.31); P < 0.00001) and days of waiting for surgery (MD = -0.75; 95% CI (-1.06, -0.44); P < 0.00001) were associated with CPWs. A reduction in inpatient expenditures was observed in CPWs compared with usual care (MD = -1197.69; 95% CI (-1582.04, -813.35); P < 0.00001). A higher score of patient satisfaction was also found in CPWs. Conclusion: CPWs could significantly improve the quality of care in patients undergoing uterine fibroids surgery, which were associated with a significant reduction in average length of stay and days of waiting for surgery, a decrease in inpatient expenditures and an improvement in patient satisfaction. Formulating evidence based CPWs and variation control in CPWs should be focused in the future.

Abstract in Chinese

用于治疗子宫肌瘤的临床路径的效果:一项荟萃分析 背景:临床路径(CPWs)用手术治疗子宫肌瘤是否有积极作用仍不清楚。 目的:评估手术治疗子宫肌瘤的临床路径的实施效果。 材料和方法:8个数据库全面检索从初期到2012年11月,这其中包括Cochrane图书馆,PubMed,EMBASE,科学网,中国生物医学文献数据库等。两个独立的研究,偏倚风险评估,提取数据。Jadad方法用于评价纳入研究质量,Meta分析采用RevMan 5.1软件进行。 结果:10项研究涉及775例病例。总的总体结果表明,缩短平均住院天数(平均差异(MD)= -1.61;95%可信区间(-1.91~-1.31);P<0.00001)和等待手术的日子(MD = -0.75;95% CI(-1.06~-0.44);P<0.00001)与临床路径相关。住院费用与常规护理相比减少(MD =-1197.69;95%可信区间(-1582.04~-813.35);P<0.00001)。病人满意度得分在临床路径中也较高。 结论:临床路径能显著改善子宫肌瘤手术患者的护理质量,减少平均住院天数和等待手术的天数,降低住院费用,提高患者满意度。未来需要考虑循证医学为根据的临床路径和变量控制。 关键词:临床路径,Meta分析,手术,子宫肌瘤

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