Effectiveness of discharge education for patients undergoing general surgery: A systematic review and meta-analysis.

Autor: Gillespie BM; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia. Electronic address: b.gillespie@griffith.edu.au., Thalib L; Istanbul Aydin University, Turkey., Harbeck E; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia., Tobiano G; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia; Gold Coast University Hospital, Gold Coast Health Nursing and Midwifery Education and Research Unit, Queensland, Australia., Kang E; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia., Tobiano S; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia., Tong M; School of Nursing & Midwifery, Griffith University, Australia., Clark J; Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia., Patel B; Gold Coast University Hospital, Queensland, Australia., Chaboyer W; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Australia.
Jazyk: angličtina
Zdroj: International journal of nursing studies [Int J Nurs Stud] 2023 Apr; Vol. 140, pp. 104471. Date of Electronic Publication: 2023 Feb 18.
DOI: 10.1016/j.ijnurstu.2023.104471
Abstrakt: Background: There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed.
Objective: To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes.
Design: Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life.
Setting: Participants were recruited from hospitals.
Participants: Adult general surgical patients.
Methods: MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest.
Results: Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied.
Conclusions: The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes.
Registration: PROSPERO CRD42021285392.
Tweetable Abstract: Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: PERSONAL RELATIONSHIPS One study in this review was undertaken by members of the author team. This study was critically appraised by two other members of the author team who were not members of that study team.
(Copyright © 2023 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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