Comparing the impact of comprehensive care with conventional care in children with congenital heart disease: a systematic review and meta-analysis

Shijian Wang; Limei He; Shengnan Liu; Xiangyun Zhang

doi:10.21037/tp-23-96

Comparing the impact of comprehensive care with conventional care in children with congenital heart disease: a systematic review and meta-analysis

Transl Pediatr. 2023 Mar 31;12(3):417-428. doi: 10.21037/tp-23-96. Epub 2023 Mar 24.

Authors

Shijian Wang^#¹, Limei He^#², Shengnan Liu¹, Xiangyun Zhang³

Affiliations

¹ Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China.
² Department of Pediatrics, Hainan Western Central Hospital, Danzhou, China.
³ Department of Cardiovascular Medicine for Children, Hainan Women and Children's Medical Center, Haikou, China.

^# Contributed equally.

Abstract

Background: This study compares the impact of comprehensive care and conventional care on interventional therapy in children with congenital heart disease and to provide a reference basis for clinical care.

Methods: Clinical randomized controlled trials (RCTs) examining care during interventional therapy in children with congenital heart disease were identified in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases using a combination of subject terms and free terms. The retrieval time was from the establishment of the database to November 27th, 2022. The control group was given conventional care and the experimental group was given comprehensive care on the basis of conventional care. The outcome indicators included one or more of postoperative complications (number of cases), puncture time (minutes), pain score (points), surgical operation time (minutes), X-ray exposure time (minutes) and length of hospital stay (days). Meta-analysis was performed using Stata 14.0 software. The publication bias test was conducted using Harbor's test.

Results: A total of 24 RCTs were eventually included, and a total of 2,028 study subjects were enrolled, including 1,025 in the test group and 1,003 in the control group. Meta-analysis showed that comprehensive care resulted in a lower risk of complications [risk ratio (RR) =0.27; 95% confidence interval (CI): 0.21 to 0.34]. Furthermore, subjects who received comprehensive care had lower puncture time [standardized mean difference (SMD) =-2.50; 95% CI: -3.23 to -1.77], lower operating time [SMD (95% CI): -2.50 (-3.31, -1.68)], lower X-ray exposition time [SMD (95% CI): -1.29 (-2.51, -0.07)], shorter length of hospital stay [SMD (95% CI): -1.57 (-2.04, -1.09)], and lower pain scores [SMD (95% CI): -2.43 (-3.20, -1.65)].

Conclusions: Comprehensive care has higher clinical utility, which is worthy of clinical application and popularization.

Keywords: Comprehensive care; congenital heart disease; interventional therapy; meta-analysis.