对接受外科服务的老年人进行老年综合评估
Appendices
Appendix 1. Search strategies
Last search conducted 13 January 2017
MEDLINE, Ovid
1. Geriatric Assessment/
2. geriatric assessment*.tw,kf.
3. Health Services for the Aged/
4. or/1‐3
5. comprehensive health care/
6. Patient Care Planning/
7. Progressive Patient Care/
8. patient care team/
9. patient‐centered care/
10. "delivery of health care, integrated"/
11. or/5‐10
12. (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or (old* adj (people or person* or resident* or adult* or patient*))).tw,kf.
13. 11 and 12
14. limit 11 to "all aged (65 and over)"
15. 4 or 13 or 14
16. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (assess* or evaluat* or apprais* or function or functioning or comprehensive* or patient care team or patient* education or interprofession* or inter‐profession* or interdisciplin* or inter‐disciplin* or multi‐disciplin* or multidisciplin* or rehab*)).tw,kf.
17. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (manage* care program* or Critical Pathway* or Program* Evaluation or case manag*)).tw,kf.
18. (geriatric adj3 (evaluation or management or program* or modif* or friendly or intervention or coordinat* or co‐ordinat*)).tw,kf.
19. (elder* adj3 (program* or modif* or friendly or intervention* or coordinat* or co‐ordinat*)).tw,kf.
20. or/16‐19
21. 15 or 20
22. exp Specialties, Surgical/
23. exp surgical procedures, operative/
24. su.fs.
25. Surgery Department, Hospital/
26. perioperative care/ or intraoperative care/ or perioperative nursing/ or postoperative care/ or preoperative care/
27. Trauma Centers/ or General Surgery/
28. (((surgery or surgical) adj (unit* or department* or area*)) or (operating adj (room* or theatre* or theater* or suite*))).mp.
29. (surgery or surgical or trauma or operation or operating or operative).ti.
30. (surgery or surgical or trauma or operation or operating or operative).kf.
31. (surgery or surgical or trauma or operation or operating or operative).ab. /freq=2
32. (perioperative or peri operative or intraoperative or intra operative or postoperative or post‐operative).ti,ab,kf.
33. or/22‐32
34. (surgery or surgical or trauma or operation or operating or operative).mp.
35. hospital*.mp.
36. 34 and 35
37. 33 or 36
38. (acute care for elders or acute care for the elderly or Nurses Improving Care for Healthsystem Elders or modified Hospital Elder Life Program or mHELP or hospitali?ed elder life program*).tw,kf.
39. (geriatrician* or geriatric specialist* or geriatric nurse* or geriatric physician*).tw,kf.
40. (geriatric unit* or geriatric ward*).tw,kf.
41. 39 or 40
42. 37 and 41
43. 21 and 37
44. geriatric trauma*.mp.
45. 42 or 43 or 44
46. randomised controlled trial.pt.
47. controlled clinical trial.pt.
48. multicenter study.pt.
49. pragmatic clinical trial.pt.
50. (randomis* or randomiz* or randomly).ti,ab.
51. groups.ab.
52. (trial or multicenter or multi center or multicentre or multi centre).ti.
53. (intervention? or effect? or impact? or controlled or control group? or (before adj5 after) or (pre adj5 post) or ((pretest or pre test) and (posttest or post test)) or quasiexperiment* or quasi experiment* or pseudo experiment* or pseudoexperiment* or evaluat* or time series or time point? or repeated measur*).ti,ab.
54. non‐randomized controlled trials as topic/
55. interrupted time series analysis/
56. controlled before‐after studies/
57. or/46‐56
58. exp animals/
59. humans/
60. 58 not (58 and 59)
61. review.pt.
62. meta analysis.pt.
63. news.pt.
64. comment.pt.
65. editorial.pt.
66. cochrane database of systematic reviews.jn.
67. comment on.cm.
68. (systematic review or literature review).ti.
69. or/60‐68
70. 57 not 69
71. 45 and 70
72. remove duplicates from 71
Embase, Ovid
1. geriatric assessment/
2. geriatric assessment*.tw,kw.
3. elderly care/
4. geriatric care/
5. geriatric nursing/ or psychogeriatric nursing/
6. or/1‐5
7. patient care planning/
8. progressive patient care/
9. 7 or 8
10. (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric or veteran* or (old* adj (people or person* or resident* or adult* or patient*))).tw,kw.
11. limit 9 to aged <65+ years>
12. 9 and 10
13. 6 or 11 or 12
14. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (assess* or evaluat* or apprais* or function or functioning or comprehensive* or patient care team or disability evaluation or patient* education or interprofession* or inter‐profession* or interdisciplin* or inter‐disciplin* or multi‐disciplin* or multidisciplin* or rehab*)).tw,kw.
15. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (manage* care program* or Critical Pathway* or Program* Evaluation or case manag*)).tw,kw.
16. (geriatric adj3 (management or program* or modif* or friendly or intervention or coordinat* or co‐ordinat*)).tw,kw.
17. (elder* adj3 (program* or modif* or friendly or intervention* or coordinat* or co‐ordinat*)).tw,kw.
18. or/14‐17
19. 13 or 18
20. exp surgery/
21. (surgery or surgical or trauma or operation or operating or operative).ti,kw.
22. general surgery/
23. perioperative period/
24. intraoperative period/
25. perioperative nursing/
26. postoperative care/
27. preoperative care/ or preoperative period/
28. (((surgery or surgical) adj (unit* or department* or area*)) or (operating adj (room* or theatre* or theater* or suite*))).tw,kw.
29. (surgery or surgical or trauma or operation or operating or operative).ab. /freq=2
30. (perioperative or peri operative or intraoperative or intra operative or postoperative or post‐operative).ti,kw.
31. (perioperative or peri operative or intraoperative or intra operative or postoperative or post‐operative).ab. /freq=2
32. or/20‐31
33. (surgery or surgical or trauma or operation or operating or operative).tw,kw.
34. hospital*.tw,kw.
35. 33 and 34
36. 32 or 35
37. 19 and 36
38. (acute care for elders or acute care for the elderly or Nurses Improving Care for Healthsystem Elders or modified Hospital Elder Life Program or mHELP or hospitali?ed elder life program*).tw,kw.
39. (geriatrician* or geriatric specialist* or geriatric nurse* or geriatric physician*).mp.
40. (geriatric unit* or geriatric ward*).mp.
41. or/38‐40
42. 36 and 41
43. geriatric trauma*.mp.
44. 37 or 42 or 43
45. exp clinical trial/
46. exp controlled study/
47. (randomis* or randomiz* or randomly).ti,ab.
48. groups.ab.
49. (trial or multicenter or multi center or multicentre or multi centre).ti.
50. (intervention? or effect? or impact? or controlled or control group? or (before adj5 after) or (pre adj5 post) or ((pretest or pre test) and (posttest or post test)) or quasiexperiment* or quasi experiment* or pseudo experiment* or pseudoexperiment* or evaluat* or time series or time point? or repeated measur*).ti,ab.
51. or/45‐50
52. (exp vertebrate/ or animal/ or exp experimental animal/ or nonhuman/ or animal.hw.) not exp human/
53. "systematic review"/
54. "journal review".pt.
55. meta analysis/
56. cochrane database of systematic reviews.jn.
57. (systematic review or literature review).ti.
58. or/52‐57
59. 51 not 58
60. 44 and 59
61. remove duplicates from 60
PsycINFO, Ovid
1. geriatric assessment/
2. geriatric assessment*.mp.
3. 1 or 2
4. treatment planning/ or aftercare/ or posttreatment followup/
5. client centered therapy/
6. integrated services/ or interdisciplinary treatment approach/
7. or/4‐6
8. (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or (old* adj (people or person* or resident* or adult* or patient*))).mp.
9. 7 and 8
10. limit 7 to "380 aged "
11. 3 or 9 or 10
12. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (assess* or evaluat* or apprais* or function or functioning or comprehensive* or patient care team or disability evaluation or patient* education or interprofession* or inter‐profession* or interdisciplin* or inter‐disciplin* or multi‐disciplin* or multidisciplin* or rehab*)).mp.
13. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (manage* care program* or Critical Pathway* or Program* Evaluation or case manag*)).mp.
14. (geriatric adj3 (evaluation or management or program* or modif* or friendly or intervention or coordinat* or co‐ordinat*)).mp.
15. (elder* adj3 (assess* or evaluation or program* or modif* or friendly or intervention* or coordinat* or co‐ordinat*)).mp.
16. or/11‐15
17. exp surgery/
18. (surgery or surgical or trauma or operation or operating or operative).mp.
19. surgical patients/
20. or/17‐19
21. 16 and 20
22. (acute care for elders or acute care for the elderly or Nurses Improving Care for Healthsystem Elders or modified Hospital Elder Life Program or mHELP or hospitali?ed elder life program*).mp.
23. (geriatrician* or geriatric specialist* or geriatric nurse* or geriatric physician*).mp.
24. (geriatric unit* or geriatric ward*).mp.
25. or/22‐24
26. 20 and 25
27. geriatric trauma*.mp.
28. 21 or 26 or 27
29. control group/
30. random$.mp.
31. (trial or multicenter or multi center or multicentre or multi centre).ti.32. ((singl$ or doubl$ or tripl$ or trebl$) adj10 (blind$ or mask$)).mp.
33. (cross?over or placebo$ or control$ or factorial or sham$).mp.
34. (intervention? or effect? or impact? or controlled or control group? or (before adj5 after) or (pre adj5 post) or ((pretest or pre test) and (posttest or post test)) or quasiexperiment* or quasi experiment* or pseudo experiment* or pseudoexperiment* or evaluat* or time series or time point? or repeated measur*).ti,ab.
35. ((clin$ or intervention$ or compar$ or experiment$ or preventive or therap$) adj10 (trial$ or study or studies)).mp.
36. exp Experimentation/ or clinical research.mp. or exp Treatment Effectiveness Evaluation/
37. (follow adj2 study).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
38. (follow adj2 studies).mp. [mp=title, abstract, heading word, table of contents, key concepts, original title, tests & measures]
39. or/29‐38
40. 28 and 39
Cochrane Central Register of Controlled Trials, Ovid EBMR
2. geriatric assessment*.tw,kf.
3. Health Services for the Aged/
4. or/1‐3
5. comprehensive health care/
6. Patient Care Planning/
7. Progressive Patient Care/
8. patient care team/
9. patient‐centered care/
10. "delivery of health care, integrated"/
11. or/5‐10
12. (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or (old* adj (people or person* or resident* or adult* or patient*))).tw,kf.
13. 11 and 12
14. limit 11 to "all aged (65 and over)"
15. 4 or 13 or 14
16. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (assess* or evaluat* or apprais* or function or functioning or comprehensive* or patient care team or patient* education or interprofession* or inter‐profession* or interdisciplin* or inter‐disciplin* or multi‐disciplin* or multidisciplin* or rehab*)).tw,kf.
17. ((frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* or old* people or old* person* or old* resident* or old* adult* or old* patient*) adj3 (manage* care program* or Critical Pathway* or Program* Evaluation or case manag*)).tw,kf.
18. (geriatric adj3 (management or program* or modif* or friendly or intervention or coordinat* or co‐ordinat*)).tw,kf.
19. (elder* adj3 (program* or modif* or friendly or intervention* or coordinat* or co‐ordinat*)).tw,kf.
20. or/16‐19
21. 15 or 20
22. exp Specialties, Surgical/
23. exp surgical procedures, operative/
24. su.fs.
25. Surgery Department, Hospital/
26. perioperative care/ or intraoperative care/ or perioperative nursing/ or postoperative care/ or preoperative care/
27. Trauma Centers/ or General Surgery/
28. (((surgery or surgical) adj (unit* or department* or area*)) or (operating adj (room* or theatre* or theater* or suite*))).mp.
29. (surgery or surgical or trauma or operation or operating or operative).ti,kf.
30. (surgery or surgical or trauma or operation or operating or operative).ab. /freq=2
31. (perioperative or peri operative or intraoperative or intra operative or postoperative or post‐operative).ti,ab,kf.
32. or/22‐31
33. (surgery or surgical or trauma or operation or operating or operative).mp.
34. hospital*.mp.
35. 33 and 34
36. 32 or 35
37. (acute care for elders or acute care for the elderly or Nurses Improving Care for Healthsystem Elders or modified Hospital Elder Life Program or mHELP or hospitali?ed elder life program*).tw,kf.
38. (geriatrician or geriatric specialist* or geriatric nurse* or geriatric physician*).tw,kf.
39. (geriatric unit* or geriatric ward*).tw,kf.
40. 38 or 39
41. 36 and 40
42. 21 and 36
43. geriatric trauma*.mp.
44. 41 or 42 or 43
CINAHL, EBSCOhost
S1 (MH "Geriatric Assessment") OR (MH "Geriatric Functional Assessment")
S2 geriatric N2 assessment
S3 (MH "Health Services for the Aged")
S4 S1 OR S2 OR S3
S5 (MH "Multidisciplinary Care Team+") OR (MH "Patient Centered Care") OR (MH "Patient Care Plans+") OR (MH "Progressive Patient Care") OR (MH "Health Care Delivery, Integrated")
S6 ( frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran* ) OR ( old* N0 (people or person* or resident* or adult* or patient*) )
S7 S5 AND S6
S8 (MH "Multidisciplinary Care Team+") OR (MH "Patient Centered Care") OR (MH "Patient Care Plans+") OR (MH "Progressive Patient Care") OR (MH "Health Care Delivery, Integrated")
Limiters ‐ Age Groups: Aged: 65+ years
S9 S4 OR S7 OR S8
S10 (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran*) N3 (assess* or evaluat* or apprais* or function or functioning or comprehensive*)
S11 (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran*) N3 ("patient care team" or "disability evaluation" or "patient* education" or interprofession* or "inter‐profession*" or interdisciplin* or "inter‐disciplin*" or "multi‐disciplin*" or multidisciplin* or rehab*)
S12 ("old* people" or "old* person*" or "old* resident*" or "old* adult*" or "old* patient*") N3 (assess* or evaluat* or apprais* or function or functioning or comprehensive*)
S13 (frail* or sarcopeni* or elder* or senior* or gerontolog* or geriatric* or veteran*) N3 ("manage* care program*" or "Critical Pathway*" or "Program* Evaluation" or "case manag*)")
S14 ("old* people" or "old* person*" or "old* resident*" or "old* adult*" or "old* patient*") N3 ("manage* care program*" or "Critical Pathway*" or "Program* Evaluation" or "case manag*)")
S15 geriatric N3 (evaluation or management or program* or modif* or friendly or intervention or coordinat* or "co‐ordinat*")
S16 elder* N3 (assess* or evaluation or program* or modif* or friendly or intervention* or coordinat* or "co‐ordinat*")
S17 S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16
S18 S9 OR S17
S19 (MH "Surgery, Operative+")
S20 (MH "Specialties, Surgical+") OR (MH "Medical‐Surgical Nursing+")
S21 TI surgery or surgical or trauma or operation or operating or operative
S22 S19 OR S20 OR S21
S23 S18 AND S22
S24 "acute care for elders" or "acute care for the elderly" or "Nurses Improving Care for Healthsystem Elders" or "modified Hospital Elder Life Program" or mHELP or "hospitalized elder life program*" or "hospitalised elder life program*"
S25 ( geriatrician* or "geriatric specialist*" or "geriatric nurse*" or "geriatric physician*" ) OR "geriatric unit* "or "geriatric ward*"
S26 S24 OR S25
S27 S22 AND S26
S28 "geriatric trauma"
S29 S23 OR S27 OR S28
S30 (MH "Clinical Trials+")
S31 PT Clinical trial
S32 TX clinic* n1 trial* OR ( TX ( (singl* n1 blind*) or (singl* n1 mask*) ) or TX ( (doubl* n1 blind*) or (doubl* n1 mask*) ) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*) ) or TX ( (trebl* n1 blind*) or (trebl* n1 mask*) ) ) OR TX randomi* control* trial*
S33 (MH "Random Assignment")
S34 TX random* allocat*
S35 TX placebo*
S36 (MH "Placebos") OR (MH "Quantitative Studies")
S37 TX allocat* random*
S38 (MH "Controlled Before‐After Studies") OR (MH "Interrupted Time Series Analysis")
S39 ( controlled or "control group*" ) OR before W5 after OR pre W5 post OR ( quasiexperiment* or "quasi experiment*" or "pseudo experiment*" or pseudoexperiment* or "time series" or "time point" or "repeated measur*" )
S40 ( pretest or "pre test" ) AND ( posttest or "post test" )
S41 S30 OR S31 OR S32 OR S33 OR S34 OR S35 OR S36 OR S37 OR S38 OR S39 OR S40
S42 S29 AND S41
S43 systematic review or meta‐analysis or literature review
S44 S42 NOT S43
Appendix 2. GRADE evidence profile geriatric care versus usual care for older adult surgical patients
Author: Eamer G, Tacheri A, Chen SS, Daviduck Q, Champers T, Shi X, Khadaroo RG
Date: 13 January 2017
Question: Geriatric Care compared to Control for older people admitted to a surgical service
Setting: Acute hospital or rehabilitation hospital following acute admission for surgical intervention
Bibliography: Eamer G, Taheri A, Chen SS, Daviduck Q, Chambers T, Khadaroo RG. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database of Systematic Reviews [Year], Issue [Issue].
| Quality assessment | № of participants | Effect | Quality | Importance | ||||||||
| № of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Geriatric care | Control | Relative | Absolute | ||
| Mortality | ||||||||||||
| 5 | Randomised trials | Not serious | Not serious | Not serious | Seriousa | None | 119/666 (17.9%) | 139/65 (21.4%) | RR 0.85 | 32 fewer per 1000 | ⊕⊕⊕◯ | CRITICAL |
| Discharge to an increased level of care | ||||||||||||
| 5 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 84/484 (17.4%) | 113/45 (24.7%) | RR 0.71 | 72 fewer per 1000 | ⊕⊕⊕⊕ | CRITICAL |
| Length of stay | ||||||||||||
| 4 | Randomized trials | Not serious | Serious b | Not serious | Not serious | None | 440 | 401 | ‐ | MD 1.47 days less | ⊕⊕⊕◯ | IMPORTANT |
| Re‐admission | ||||||||||||
| 3 | Randomized trials | Not serious | Not serious | Not serious | Serious a | None | 116/368 (31.5%) | 118/37 (31.6%) | RR 1.00 | 0 fewer per 1000 | ⊕⊕⊕◯ | IMPORTANT |
| Total cost | ||||||||||||
| 1 | Randomized trials | Not serious | Not serious | Not serious | Not serious | Incomplete measurement of cost c | 198 | 199 | ‐ | MD EUR 5154 less | ⊕⊕⊕◯ | IMPORTANT |
| Major complication | ||||||||||||
| 2 | Randomized trials | Not serious | Serious b | Not serious | Serious a | None | 112/282 (39.7%) | 138/29 (46.5%) | RR 0.90 | 79 fewer per 1000 | ⊕⊕◯◯ | IMPORTANT |
| Major complication ‐ delirium | ||||||||||||
| 3 | Randomized trials | Serious d | Not serious | Not serious | Serious a | Strong association | 84/344 (24.4%) | 118/361 (32.7%) | RR 0.75 | 96 fewer per 1000 | ⊕⊕◯◯ | IMPORTANT |
CI: Confidence interval; RR: Risk ratio; MD: Mean difference. Footnotes a: There are wide confidence intervals that include both no effect and a high risk of benefit or harm. b: There was significant variability between studies for this outcome. c: Costing was calculated in an imprecise manner (costs are presented as the total cost over one year, however the admission cost did not include rehabilitation hospital costs despite the authors identifying a higher proportion of control patients being transferred to rehabilitation centres before discharge). d: Risk of bias in assessment of outcome in one study.
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Geriatric care versus control, Outcome 1 Mortality.
Comparison 1 Geriatric care versus control, Outcome 2 Discharge to an increased level of care.
Comparison 1 Geriatric care versus control, Outcome 3 Length of stay.
Comparison 1 Geriatric care versus control, Outcome 4 Re‐admission.
Comparison 1 Geriatric care versus control, Outcome 5 Major complication.
Comparison 1 Geriatric care versus control, Outcome 6 Major complication ‐ delirium.
| Comprehensive geriatric assessment for older people admitted to a surgical service | ||||||
| Patient or population: Improving outcomes in older adult people admitted to a surgical service. | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with control | Risk with geriatric care | |||||
| Mortality | 214 per 1000 | 182 per 1000 | RR 0.85 | 1316 | ⊕⊕⊕◯ 1 | Hip fracture studies. |
| Discharge to an increased level of care | 247 per 1000 | 176 per 1000 | RR 0.71 | 941 | ⊕⊕⊕⊕ | Hip fracture studies. |
| Length of stay | Meta‐analysis was not performed due to high heterogeneity (Analysis 1.3) | MD in studies ranged from ‐12.8 days to 8.3 days | ‐ | 841 | ⊕⊕⊕⊝ | Hip fracture studies ‐ length of stay until final discharge from hospital (including rehabilitation hospital). Meta‐analysis was not retained due to high heterogeneity (I² = 88%, P < 0.00001). |
| Re‐admission | 316 per 1000 | 316 per 1000 | RR 1.00 | 741 | ⊕⊕⊕⊝ | All studies included; removing elective surgical oncology study doesn't change effect. |
| Total cost | The mean total cost was EUR 59,486 | MD EUR 5154 lower | 397 | ⊕⊕⊕⊝ | 1 study reported cost. | |
| Major complication | Meta‐analysis was not performed due to high heterogeneity (Analysis 1.5) | Two studies reported this outcome with RRs of 0.74 and 1.16 | 579 | ⊕⊕⊝⊝ | Hempenius 2013 defined major as 2 or more complications. Vidán 2005 defined major as delirium, congestive heart failure, pneumonia, DVT, PE, pressure ulcer, arrhythmia and myocardial infarction. Meta‐analysis was not retained due to high heterogeneity (I² = 77%, P = 0.04). | |
| Major complication ‐ delirium | 327 per 1000 | 245 per 1000 | RR 0.75 | 705 | ⊕⊕⊝⊝ | Delirium assessed by Delirium Observation Scale (Hempenius 2013) or confusion assessment method (Marcantonio 2001; Vidán 2005) |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 We downgraded due to imprecision because there were wide confidence intervals that include both no effect and a high risk of benefit or harm. 2 We downgraded due to inconsistency because there was significant variability among studies. 3 We downgraded due to other considerations because costing was calculated in an imprecise manner (costs are presented as the total cost over one year, however the admission cost did not include rehabilitation hospital costs despite the authors identifying a higher proportion of control patients being transferred to rehabilitation centres before discharge). 4 We downgraded due to the high risk of bias. | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Mortality Show forest plot | 5 | 1316 | Risk Ratio (IV, Random, 95% CI) | 0.85 [0.68, 1.05] |
| 1.1 4 to 6 months | 2 | 476 | Risk Ratio (IV, Random, 95% CI) | 0.74 [0.46, 1.20] |
| 1.2 1 year | 3 | 840 | Risk Ratio (IV, Random, 95% CI) | 0.87 [0.69, 1.11] |
| 2 Discharge to an increased level of care Show forest plot | 5 | 941 | Risk Ratio (IV, Random, 95% CI) | 0.71 [0.55, 0.92] |
| 2.1 Discharge | 1 | 108 | Risk Ratio (IV, Random, 95% CI) | 0.31 [0.12, 0.79] |
| 2.2 4 to 6 months | 2 | 344 | Risk Ratio (IV, Random, 95% CI) | 0.81 [0.54, 1.21] |
| 2.3 1 year | 2 | 489 | Risk Ratio (IV, Random, 95% CI) | 0.73 [0.52, 1.03] |
| 3 Length of stay Show forest plot | 5 | Mean Difference (IV, Random, 95% CI) | Totals not selected | |
| 3.1 Acute hospital discharge | 1 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 3.2 Discharge | 4 | Mean Difference (IV, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 4 Re‐admission Show forest plot | 3 | 741 | Risk Ratio (IV, Random, 95% CI) | 1.00 [0.76, 1.32] |
| 4.1 1 to 3 months | 1 | 225 | Risk Ratio (IV, Random, 95% CI) | 1.25 [0.74, 2.09] |
| 4.2 1 year | 2 | 516 | Risk Ratio (IV, Random, 95% CI) | 0.95 [0.67, 1.33] |
| 5 Major complication Show forest plot | 2 | Risk Ratio (IV, Fixed, 95% CI) | Totals not selected | |
| 5.1 Discharge | 2 | Risk Ratio (IV, Fixed, 95% CI) | 0.0 [0.0, 0.0] | |
| 6 Major complication ‐ delirium Show forest plot | 3 | Risk Ratio (IV, Random, 95% CI) | Subtotals only | |
| 6.1 Discharge | 3 | 705 | Risk Ratio (IV, Random, 95% CI) | 0.75 [0.60, 0.94] |
