1. Metabolic syndrome; associations with adverse outcome after colorectal surgery. A systematic review and meta-analysis
- Author
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R.M.H. Roumen, A.G. Lieverse, L. Janssen, C.D. Slooter, G.D. Slooter, and M. Reudink
- Subjects
medicine.medical_specialty ,Adverse outcomes ,Review ,Preoperative care ,Postoperative outcome ,RR, Risk Ratio ,WHO, World Health Organization ,Colorectal surgery ,Internal medicine ,NOS, Newcastle-Ottawa Scale ,medicine ,IDF, International Diabetes Federation ,MetS, Metabolic Syndrome ,CRC, Colorectal cancer ,AHA/NHLBI, American Heart Association/National heart Lung and Blood Institute Scientific Statement ,BG, Blood glucose ,FPG, Fasting Plasma Glucose ,business.industry ,CI, Confidence interval ,ERAS, Enhanced Recovery After Surgery ,General Medicine ,medicine.disease ,NCEP ATP III, National Cholesterol Education Program Adult Treatment Panel III ,Metabolic syndrome ,SSI, Surgical site infection ,Meta-analysis ,Hyperglycemia ,HbA1c, Hemglobin A1c ,CAL, Colorectal anastomotic leakage ,Surgery ,Observational study ,AMSTAR, A MeaSurement Tool to Assess systematic Reviews ,BMI, Body Mass Index ,business ,Complication ,LoS, Length of stay ,PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses ,Abdominal surgery ,NHLBI, National Heart, Lung, and Blood Institute - Abstract
Background Increasing evidence shows that patients with Metabolic Syndrome (MetS) are at risk for adverse outcome after abdominal surgery. The aim of this study was to investigate the impact of MetS and preoperative hyperglycemia, as an individual component of MetS, on adverse outcome after colorectal surgery. Methods A literature review was systematically performed according to the PRISMA guidelines. Inclusion criteria were observational studies that evaluated the relationship between MetS or preoperative hyperglycemia and outcomes after colorectal surgery (i.e. any complication, severe complication defined as Clavien-Dindo grade ≥ III, anastomotic leakage, surgical site infection, mortality and length of stay). Results Six studies (246.383 patients) evaluated MetS and eight studies (9.534 patients) reported on hyperglycemia. Incidence rates of MetS varied widely from 7% to 68% across studies. Meta-analysis showed that patients with MetS are more likely to develop severe complications than those without MetS (RR 1.62, 95% CI 1.01–2.59). Moreover, a non-significant trend toward increased risks for any complication (RR 1.35, 95% CI 0.91–2.00), anastomotic leakage (RR 1.67, 95% CI 0.47–5.93) and mortality (RR 1.19, 95% CI 1.00–1.43) was found. Furthermore, preoperative hyperglycemia was associated with an increased risk of surgical site infection (RR 1.35, 95% CI 1.01–1.81). Conclusion MetS seem to have a negative impact on adverse outcome after colorectal surgery. As a result of few studies meeting inclusion criteria and substantial heterogeneity, evidence is not conclusive. Future prospective observational studies should improve the amount and quality in order to verify current results., Highlights • The prevalence of metabolic syndrome (MetS) in colorectal surgery patients is 7–68%. • MetS increases the risk of severe complications after colorectal surgery. • Preoperative hyperglycemia, as an individual component of MetS, is associated with surgical site infection. • Identification of MetS could be valuable in preoperative risk stratification.
- Published
- 2021