门诊与住院颈前路椎间盘切除术和融合术的安全性:一项系统回顾和荟萃分析。

IF 2.4 3区 生物学 Q2 MULTIDISCIPLINARY SCIENCES
PeerJ Pub Date : 2025-09-22 eCollection Date: 2025-01-01 DOI:10.7717/peerj.20045
Lili Ding, Mengzhu Yin, Wenhua Yuan
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引用次数: 0

摘要

目的:评价和比较门诊和住院前路颈椎椎间盘切除术融合术(ACDF)在并发症和相关结果方面的安全性。方法:系统检索PubMed、Embase和Scopus,检索2000年1月1日至2024年12月31日发表的回顾性队列研究,比较门诊和住院患者ACDF。采用随机效应模型计算合并相对风险(rr)和加权平均差异(wmd)。研究质量和证据的确定性分别使用纽卡斯尔-渥太华量表(NOS)和GRADE进行评估。结果:共纳入21项研究,涉及164541例患者(门诊36361例,住院128180例)。门诊ACDF导致总并发症发生率(RR 0.45, 95% CI[0.35-0.57])、死亡率(RR 0.35, 95% CI[0.16-0.77])、深静脉血栓形成(RR 0.56, 95% CI[0.37-0.85])和伤口并发症(RR 0.59, 95% CI[0.52-0.68])显著降低。意外再手术(RR 0.33, 95% CI[0.24-0.46])、再入院(RR 0.57, 95% CI[0.46-0.70])和肺部并发症(RR 0.43, 95% CI[0.27-0.68])的风险也有所降低。卒中、吞咽困难、血肿、肾脏和心脏并发症的风险在两组之间具有可比性。由于高异质性、回顾性研究设计和间接性,证据的确定性被评为低至极低。结论:与精心挑选的住院患者相比,门诊ACDF的并发症更少。然而,研究的回顾性、选择性偏倚的可能性和低确定性证据强调需要高质量的前瞻性研究来验证这些结果并为临床实践提供信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Safety of outpatient vs. inpatient anterior cervical discectomy and fusion: a systematic review and meta-analysis.

Objective: To evaluate and compare the safety of outpatient and inpatient anterior cervical discectomy and fusion (ACDF) regarding complications and related outcomes.

Methods: PubMed, Embase, and Scopus were systematically searched for retrospective cohort studies published between January 1, 2000, and December 31, 2024, comparing outpatient and inpatient ACDF. Pooled relative risks (RRs) and weighted mean differences (WMDs) were calculated using a random-effects model. Study quality and certainty of evidence were assessed using the Newcastle-Ottawa Scale (NOS) and GRADE, respectively.

Results: A total of 21 studies involving 164,541 patients (36,361 outpatient and 128,180 inpatient) were included. Outpatient ACDF resulted in significantly lower incidence of overall complications (RR 0.45, 95% CI [0.35-0.57]), mortality (RR 0.35, 95% CI [0.16-0.77]), deep vein thrombosis (RR 0.56, 95% CI [0.37-0.85]), and wound complications (RR 0.59, 95% CI [0.52-0.68]). Reduced risks were also observed for unplanned reoperations (RR 0.33, 95% CI [0.24-0.46]), readmissions (RR 0.57, 95% CI [0.46-0.70]), and pulmonary complications (RR 0.43, 95% CI [0.27-0.68]). Risks of stroke, dysphagia, hematoma, and renal and cardiac complications were comparable between the groups. The certainty of evidence was rated low to very low due to high heterogeneity, retrospective study designs, and indirectness.

Conclusion: Outpatient ACDF is associated with fewer complications as compared to inpatient procedures for carefully selected patients. However, the retrospective nature of the studies, the possibility of selection bias, and low-certainty evidence underscore the need for high-quality prospective research to validate these results and inform clinical practice.

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来源期刊
PeerJ
PeerJ MULTIDISCIPLINARY SCIENCES-
CiteScore
4.70
自引率
3.70%
发文量
1665
审稿时长
10 weeks
期刊介绍: PeerJ is an open access peer-reviewed scientific journal covering research in the biological and medical sciences. At PeerJ, authors take out a lifetime publication plan (for as little as $99) which allows them to publish articles in the journal for free, forever. PeerJ has 5 Nobel Prize Winners on the Board; they have won several industry and media awards; and they are widely recognized as being one of the most interesting recent developments in academic publishing.
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