Perioperative Care Pathways in Low- and Lower-Middle-Income Countries: Systematic Review and Narrative Synthesis.

Autor: Patel J; Division of Surgery and Interventional Science, Centre for Perioperative Medicine, University College London, London, UK., Tolppa T; Network for Improving Critical Care Systems and Training, YMBA Building, Colombo, 08, Sri Lanka.; Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand., Biccard BM; Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa., Fazzini B; Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, E1 1FR, UK., Haniffa R; Network for Improving Critical Care Systems and Training, YMBA Building, Colombo, 08, Sri Lanka.; Mahidol Oxford Tropical Medicine Research Unit, Bangkok, 10400, Thailand., Marletta D; Library Services, University College London, London, UK., Moonesinghe R; Division of Surgery and Interventional Science, Centre for Perioperative Medicine, University College London, London, UK., Pearse R; Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, c/o ACCU Research Team, Royal London Hospital, Queen Mary University of London, London, E1 1BB, UK., Vengadasalam S; Department of Surgery, Jaffna Teaching Hospital, Jaffna, 40000, Sri Lanka., Stephens TJ; Critical Care and Perioperative Medicine Research Group, William Harvey Research Institute, c/o ACCU Research Team, Royal London Hospital, Queen Mary University of London, London, E1 1BB, UK. t.t.stephens@qmul.ac.uk., Vindrola-Padros C; Division of Surgery, Department of Targeted Intervention, University College London, London, UK.
Jazyk: angličtina
Zdroj: World journal of surgery [World J Surg] 2022 Sep; Vol. 46 (9), pp. 2102-2113. Date of Electronic Publication: 2022 Jun 22.
DOI: 10.1007/s00268-022-06621-x
Abstrakt: Background: Safe and effective care for surgical patients requires high-quality perioperative care. In high-income countries (HICs), care pathways have been shown to be effective in standardizing clinical practice to optimize patient outcomes. Little is known about their use in low- and middle-income countries (LMICs) where perioperative mortality is substantially higher.
Methods: Systematic review and narrative synthesis to identify and describe studies in peer-reviewed journals on the implementation or evaluation of perioperative care pathways in LMICs. Searches were conducted in MEDLINE, EMBASE, CINAHL Plus, WHO Global Index, Web of Science, Scopus, Global Health and SciELO alongside citation searching. Descriptive statistics, taxonomy classifications and framework analyses were used to summarize the setting, outcome measures, implementation strategies, and facilitators and barriers to implementation.
Results: Twenty-seven studies were included. The majority of pathways were set in tertiary hospitals in lower-middle-income countries and were focused on elective surgery. Only six studies were assessed as high quality. Most pathways were adapted from international guidance and had been implemented in a single hospital. The most commonly reported barriers to implementation were cost of interventions and lack of available resources.
Conclusions: Studies from a geographically diverse set of low and lower-middle-income countries demonstrate increasing use of perioperative pathways adapted to resource-poor settings, though there is sparsity of literature from low-income countries, first-level hospitals and emergency surgery. As in HICs, addressing patient and clinician beliefs is a major challenge in improving care. Context-relevant and patient-centered research, including qualitative and implementation studies, would make a valuable contribution to existing knowledge.
(© 2022. The Author(s).)
Databáze: MEDLINE
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