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Effects of clinical pathways used in surgery for uterine fibroids: a meta-analysis.

BACKGROUND
Whether clinical pathways (CPWs) used in surgery for uterine fibroids have positive effects or not remains unclear.


AIMS
To assess the implementation effectsof CPW sin surgery for uterine fibroids.


MATERIALS AND METHODS
Eight databases were searched comprehensively from inception to November 2012, which including the Cochrane Library, PubMed, EMBASE, Web of Science, Chinese Biomedical Literature Database, etc. Two reviewers selected studies, assessed risk of bias, and extracted data of included studies independently. Jadad methodological approach was applied to assess the quality of included studies and meta-analysis was conducted by RevMan 5.1 software.


RESULTS
Ten studies involving 775 patients were included. The aggregate overall results showed that a shorter average length of stay (mean difference (MD) = -1.61; 95% CI (-1.91, -1.31); P < 0.00001) and days of waiting for surgery (MD = -0.75; 95% CI (-1.06, -0.44); P < 0.00001) were associated with CPWs. A reduction in inpatient expenditures was observed in CPWs compared with usual care (MD = -1197.69; 95% CI (-1582.04, -813.35); P < 0.00001). A higher score of patient satisfaction was also found in CPWs.


CONCLUSION
CPWs could significantly improve the quality of care in patients undergoing uterine fibroids surgery, which were associated with a significant reduction in average length of stay and days of waiting for surgery, a decrease in inpatient expenditures and an improvement in patient satisfaction. Formulating evidence based CPWs and variation control in CPWs should be focused in the future.