Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.
Clin Nutr. 2016 Apr;35(2):308-316. doi: 10.1016/j.clnu.2015.03.007. Epub 2015 Mar 17.
BACKGROUND & AIMS: Diabetes is a significant risk factor for surgical complications and also increases the prevalence of comorbidities, thereby increasing surgical risk. The aim of this systematic review was to establish the relationship between long-term preoperative glycemic control as measured by HbA1c and postoperative complications.
A systematic search was conducted to source articles published between 1980 and 2014 pertinent to the review. Full-text articles were included if they met the pre-determined criteria as determined by two reviewers. Studies reporting the impact of preoperative HbA1c levels on postoperative outcomes in all disciplines of surgery were included.
Twenty studies, including a total of 19,514 patients with diabetes mellitus from a range of surgical specialties, were suitable for inclusion. Preoperative glycemic control did not have a bearing on 30-day mortality. There were no significant differences in the incidence of stroke, venous thromboembolic disease, hospital readmission and ITU length of stay based on glycemic control. The majority of studies suggested no link between preoperative HbA1c levels and acute kidney injury or need for postoperative dialysis, dysrhythmia, infection not related to the surgical site and total hospital length of stay. The literature was highly variable with regards to myocardial events, surgical site infection and reoperation rates.
Elevated preoperative HbA1c was not definitively associated with increased postoperative morbidity or mortality in patients with diabetes mellitus. The studies included in this review were relatively heterogeneous, predominantly retrospective, and often contained small patient numbers, suggesting that good quality evidence is necessary.
糖尿病是手术并发症的重要危险因素，同时也增加了合并症的发病率，从而增加了手术风险。本系统评价的目的是确定长期术前糖化血红蛋白（HbA1c）控制与术后并发症之间的关系。
系统检索了 1980 年至 2014 年期间发表的与本综述相关的文章。如果两篇评审员都认为符合预先设定的标准，则纳入全文文章。纳入研究报告了术前 HbA1c 水平对所有外科专业术后结局的影响。
共有 20 项研究，包括来自多个外科专业的 19514 例糖尿病患者，适合纳入。术前血糖控制与 30 天死亡率无关。根据血糖控制情况，脑卒中、静脉血栓栓塞疾病、医院再入院和 ICU 住院时间无显著差异。大多数研究表明，术前 HbA1c 水平与急性肾损伤或需要术后透析、心律失常、与手术部位无关的感染以及总住院时间之间没有联系。关于心肌事件、手术部位感染和再次手术率，文献差异很大。
在糖尿病患者中，术前 HbA1c 升高与术后发病率或死亡率增加并无明确相关性。本综述纳入的研究相对较为混杂，主要是回顾性的，且常常包含小样本量，表明需要高质量的证据。
