Health and health related outcomes of Chinese adult surgical patients managed by a nurse-led discharge service: A meta-analysis.

Background: Patients' discharge from the hospital is a major factor for the continuous normal functioning of the inpatient health care service. A nurse-led discharge service for surgical patients in China refers to the fact where, with the advice of the treating doctor, a senior trained nurse takes the main responsibility to prepare and manage a post-operative patient's discharge from the hospital, rather than solely depending on the corresponding physician to handle the discharge process. However, conclusions from individual studies are often controversial. Meta-analyses provide more precise estimates of the effect size compared to that of any single study that could have been achieved, reducing the uncertainty of results thereby generating a more efficient overall estimate of the effect providing a single, synthesized conclusion with high level evidence that could be used to develop clinical practice guidelines and inform decision-making in various fields. Therefore, because of the several positive aspects of meta-analyses compared to a single individual study, we aimed to systematically show the health and health related outcomes of Chinese adult surgical patients managed by a nurse-led discharge service through a meta-analysis. Methods: MEDical Literature Analysis and Retrieval System Online, Web of Science, Excerpta Medica dataBASE, the Cochrane library, Google scholar and http://www.Clinicaltrials.gov were the search databases. In this meta-analysis, the statistical work was carried out by the RevMan software version 5.4. For dichotomous data, risk ratios (RR) with 95% confidence intervals (CI) were used to represent the results following the meta-analysis. For continuous data, mean and standard deviation were the inputs, and weighted mean differences (WMD) with 95% CI were used to represent the results following the meta-analysis. Results: A total number of 1059 participants were included in this meta-analysis whereby 504 patients were assigned to the nurse-led discharge group whereas 555 patients were assigned to the control group. Most of the studies were randomized trials and participants were enrolled from year 2001 to 2024. All the participants were of Chinese origin and were from mainland China, Hong Kong or Taiwan. Results of this meta-analysis showed that this nurse-led discharge service in Chinese adult surgical inpatients was associated with a significantly lower risk of re-admission with RR: 0.46, 95% CI: 0.30 - 0.70; Conclusions: Based on the results of this meta-analysis, a nurse-led discharge service in Chinese adult surgical inpatients is effective in terms of reducing the risk of re-admission to the hospital. However, no significant difference has been observed in terms of improving mortality risk, the length of hospital stay and the quality of life. Even though our meta-analysis could clarify inconsistent finding from individual studies, providing a single, synthesized conclusion, with higher level evidence, newer larger studies would be required to confirm whether a nurse-led discharge service would really be effective in China due to limited data.