術前造口部位標記對患者預后的有效性：系統評價和薈萃分析
宗旨
本研究系統地回顧了有關術前造口部位標記的文獻，并討論了手術對并發癥發生率、自我護理缺陷和健康相關生活質量 (HRQOL) 的有效性。
數據源
按照 PRISMA 指南進行系統評價。檢索 PubMed、EMBASE、Cochrane 和 CINAHL 數據庫以獲得以英文發表的文章。也從韓國數據庫中檢索文章。最后一次檢索在 2019 年 6 月 2 日進行。
復習方法
兩名評價員獨立選擇相關研究，評估其方法學質量并提取數據。納入實驗和觀察研究。主要關注并發癥發生率、自我護理缺陷和 HRQOL。使用統計軟件spss 25.0 和 Stata 13.0進行薈萃分析。
結果
在檢索的 1,039 篇文章中，納入20 篇，19 篇用于定量合成。術前造口部位標記降低了并發癥發生率（比值比 [OR]：0.47；95% 置信區間 [CI]：0.36-0.62；I 2：70.6%），降低了自我護理缺陷（OR：0.34；95% CI：0.18） –0.64；I 2 : 0%），并且 HRQOL 增加（標準化平均差，1.05；95% CI：0.70–1.40；I 2 : 0%）。個別研究和整體研究的質量評估結果都非常好。發表偏倚的可能性很低。
結論
我們的研究結果表明，術前造口部位標記改善了患者的預后：造口相關并發癥發生率和自我護理缺陷減少，HRQOL 上升。出于這個原因，術前造口部位標記應該是臨床環境中的強制性程序。這種做法還應得到政策制定者和醫療保健專家協會的支持。
影響
術前造口部位標記可將整體并發癥發生率降低 53%，將皮膚問題降低 59%。術前造口部位標記還可以提高自我保健和健康相關的生活質量。我們建議術前造口部位標記應成為臨床環境中的強制性程序。
Aims
This study systematically reviews the literature regarding preoperative stoma site marking and discusses the effectiveness of the procedure on complication rates, self-care deficits and health-related quality of life (HRQOL).
Design
Systematic review and meta-analysis.
Data source
Our review was conducted following the PRISMA guidelines. PubMed, EMBASE, Cochrane and CINAHL databases were searched to obtain articles published in English. Articles were also retrieved from Korean databases as well. Our last search was conducted on 2 June 2019.
Review methods
Two reviewers independently selected relevant studies, evaluated their methodological quality and extracted data. Experimental and observational studies were included. Our main focus was on complication rates, self-care deficits and HRQOL. We conducted meta-analysis using the statistical software spss 25.0 and Stata 13.0.
Results
Of the 1,039 articles reviewed, 20 were included for review, and 19 were used for quantitative synthesis. Preoperative stoma site marking reduced complication rates (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.36–0.62; I2: 70.6%), lowered self-care deficits (OR: 0.34; 95% CI: 0.18–0.64; I2: 0%), and increased HRQOL (standardized mean difference, 1.05; 95% CI: 0.70–1.40; I2: 0%). Quality appraisal results for both the individual studies and the studies overall were excellent. The possibility of publication bias was low.
Conclusions
Our findings indicate that preoperative stoma site marking improves patient outcomes: stoma-related complication rates and self-care deficits decrease and HRQOL rises. For this reason, preoperative stoma site marking should be a mandatory procedure in clinical settings. The practice should also be supported by policymakers and healthcare expert associations.
Impact
Preoperative stoma site marking reduces overall complication rates by 53% and skin problems by 59%. Preoperative stoma site marking also improves self-care and health-related quality of life. We recommend that preoperative stoma site marking should be a mandatory procedure in clinical settings.
