Associations Between Care Bundles and Postoperative Outcomes After Major Emergency Abdominal Surgery: A Systematic Review and Meta-Analysis.

INTRODUCTION: Care bundles were found to improve postoperative outcomes in elective surgery. However, in major emergency general surgery studies show a divergent impact on mortality and length of stay. This meta-analysis aimed to evaluate associations between care bundles and mortality, complications, and length of stay when applied in major emergency general surgery. METHODS: A systematic literature search in PubMed and Embase was performed on the May 1, 2021. Only comparative studies on care bundles in major emergency general surgery were included. Meta-analysis and trial sequential analysis were performed on 30-d mortality. We undertook a narrative approach of long-term mortality, complications, and length of stay. RESULTS: Meta-analysis of 13 studies with 35,771 patients demonstrated that care bundles in emergency surgery were not associated with a significant reduction in odds of 30-d mortality (odds ratio = 0.8, 95% confidence interval 0.62-1.03). Trial sequential analysis confirmed that the meta-analysis was underpowered with a minimum of 78,901 patients required for firm conclusions. Seven studies reported complication rates whereof six reported lower complication rates using care bundles. CONCLUSIONS: Care bundles were reported to decrease postoperative complications in five out of seven studies and seven out of 11 studies reported a shortening in length of stay.

Adherence to and outcomes of bundle care in major abdominal emergency surgery.

INTRODUCTION: Care bundles to improve post-operative outcomes after major abdominal emergency surgery have proven to be effective. This study investigated the correlation between adherence to protocol and post-operative outcomes after implementing perioperative bundle care at a single hospital. METHODS: This was a retrospective cohort study. Data were collected from 2018 to 2019. Patients undergoing surgery due to major emergency abdominal pathophysiology were included. The care bundle covered the pre-, intra- and post-operative course and included 12 elements. High adherence was defined as the completion of 70% of the elements. We used the Clavien-Dindo Classification and the Comprehensive Complication Index to evaluate post-operative complications. RESULTS: A total of 120 patients were included. High adherence was obtained in 54% of the patients. We found no difference in post-operative mortality or complications when comparing high adherence with low adherence. However, cases with high protocol adherence had a longer length of stay. CONCLUSIONS: We found no difference in mortality or complications. Patients with a high adherence had a longer hospital stay. FUNDING: none Trial registration. not relevant.