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Br J Surg
Br J Surg
bjs
The British Journal of Surgery
0007-1323
1365-2168
Oxford University Press UK

10.1093/bjs/znae234
znae234
Correspondence
AcademicSubjects/MED00910
Bjs/2
Comment on: Protocolized care pathways in emergency general surgery: a systematic review and meta-analysis
Luo Hua Department of Orthopaedics, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China

Su Yongwei Department of Orthopaedics, First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China

https://orcid.org/0000-0002-8306-8312
Ren Yu Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, China

Correspondence to: Yu Ren, Department of Pharmacy, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, 150 Ximen Road, Taizhou 317000, Zhejiang, China (e-mail: reny1007@sina.com)
9 2024
18 9 2024
18 9 2024
111 9 znae23411 7 2024
17 7 2024
© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.
2024
https://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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pmc Dear Editor

We read with interest the article by Harji et al.1. The study suggests that protocolized care pathways reduce hospital stays, complications such as postoperative pneumonia and infections, and improve gastrointestinal function. We appreciate the authors’ efforts but noticed several issues that need addressing.

First, the authors mentioned that ‘Four RCTs reported mean length of hospital… Protocolized care pathways were associated with a significantly shorter length of stay…… (SMD −2.47……P = 0.002; Fig. 2) in result’. However, Fig. 2 includes five studies (4 RCTs and 1 retrospective study). This appears to be an error, and the summary figure should include only the RCTs, as shown in our corrected Fig. S1.

Second, several outcomes show high heterogeneity (length of stay I² = 97%, time to flatus I² = 96%, time to defaecation I² = 98%, time to diet I² = 98%). The authors did not explore the sources of this heterogeneity or conduct sensitivity analyses, which may reduce the reliability of the results.

Third, there are multiple errors in Fig. 1. After removing 571 duplicates from 2756 articles, 2185 should remain, but Fig. 1 shows 2188. Then, 907 articles were excluded, leaving 21 for full-text review, but it is unclear what happened to the remaining 1260 articles.

Fourth, the conclusions do not adequately consider the heterogeneity of the included populations and protocolized care pathways. Significant differences in age, sex, ASA grades, types of surgery, and complexity can influence results. Additionally, variations in pathway components and adherence rates affect comparability and overall analysis. These issues limit the validity and generalizability of the conclusions, as the study does not fully address these heterogeneities.

We acknowledge the authors’ contributions and hope our suggestions help refine their future research. We look forward to their feedback.

Supplementary Material

znae234_Supplementary_Data

Supplementary material

Supplementary material is available at BJS online.

Author contributions

Hua Luo (Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review & editing), Yongwei Su (Conceptualization, Investigation, Project administration, Resources), and Yu Ren (Funding acquisition, Investigation, Methodology, Project administration, Supervision, Validation, Visualization, Writing—original draft, Writing—review & editing)
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Reference

1 Harji  DP, Griffiths  B, Stocken  D, Pearse  R, Blazeby  J, Brown  JM. Protocolized care pathways in emergency general surgery: a systematic review and meta-analysis. Br J Surg  2024;111 :znae057
