Postoperative complications, length of stay, and mortality following colectomies in rural hospitals: a systematic review and meta-analysis

ABSTRACT

Introduction

Studies regarding patients who have underwent colectomy reported contradictory post-surgical complications based on their living areas. Due to the conflicting data surrounding whether rural or urban hospitals have lower postoperative complication rates, we have performed a systematic review and meta-analysis with the aim of understanding and assessing the evidence that has already been found.

Methods

The online databases PubMed, MEDLINE, EMBASE, SCOPUS, and CINAHL were searched for our literature review. We included papers with data on the postoperative complication rates for patients who had undergone colectomies. The patients were stratified based on the location status of the hospital, i.e. rural or urban. Data analysis was performed in Cochrane’s Review Manager 5.41 software.

Results

A total of 921 studies were identified in the initial search; the inclusion and exclusion criteria refined the search results in 11 studies for review. The primary outcomes analyzed were mortality rate, length of stay and total complication rate. This review found that rural hospitals had either equal or lower inpatient postoperative mortality rates in comparison to urban hospitals for patients who had undergone colectomies. However, rural hospitals had a longer length of stay (mean length of stay in rural hospitals was 6.7 days and in urban hospitals was 4.9 days). It is important to note that the Australian hospitals had a mean length of stay of 13.5 days, which was almost double that of rural hospitals in America. The unadjusted rate of total complication was 26.51% in rural hospitals.

Conclusions

Rural hospitals overall have equivalent postoperative complication rates to urban hospitals and can provide sufficient postoperative patient care.

KEYWORDS:

• Colectomies
• postoperative complications
• length of stay
• mortality
• rural hospitals
• systematic review

Disclosure of any financial/other competing interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Data availability statement

The datasets used and/or analyzed during the current review are associated with the submitted manuscript.

Authors’ contributions

NV & RJ made substantial contributions to conception and design, acquisition of data, analysis, and interpretation of data. Responsible for drafting the manuscript and revising it critically for important intellectual content. MH made substantial contributions to shaping the conception and design. Involved in drafting the manuscript and revising it critically for important intellectual content. AV involved in reviewing the manuscript, contribute to developing methodological and oncological frames, and revising it critically for important intellectual content. All authors read and approved the final manuscript.

Additional information

Funding

This paper was not funded.