Department of Public Health Sciences, Penn State Hershey College of Medicine and Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA.
Syst Rev. 2020 Jul 13;9(1):158. doi: 10.1186/s13643-020-01416-4.
Early postoperative hyperglycemia (POHG) is common and associated with poor postoperative outcomes. Currently, there is no systematic review and meta-analysis that addresses the knowledge gap of the incidence of POHG in surgical patients and that explores the associated risk factors and complications. The objective of this study will be to estimate the pooled incidence, risk factors, and clinical outcomes of early postoperative hyperglycemia in men and women globally.
We designed and registered a study protocol for a systematic review and meta-analysis of studies reporting the incidence of postoperative hyperglycemia (POHG). We will search PubMed (MEDLINE), Scopus, Web of Science, EMBASE, Cochrane Library, OVID (HEALTH STAR), OVID (MEDLINE), and Joana Briggs Institute EBF Database (from inception onwards). Randomized controlled trials and observational cohort studies reporting the incidence of POHG and conducted in surgical patients will be included. No age, geographical location, study design, or language limits will be applied. The primary outcome will be the incidence of POHG. Secondary outcomes will be risk factors and clinical outcomes of POHG. Two reviewers will independently screen citations, full text articles, and abstract data, extract data, and evaluate the quality and bias of included studies. Discrepancies will be resolved through discussion or consultation with a third researcher. The risk of bias and study methodological quality of included studies will be evaluated by the appropriate Cochrane risk of bias tool for randomized trials and Newcastle-Ottawa Scale for cohort studies. If feasible, we will conduct random effects meta-analysis with a logit transformation of proportions. We will report the probability of postoperative hyperglycemia as a measure of incidence rate, relative risk ratios (RR), and 95% confidence intervals to report the effects of the risk factors and postoperative outcomes. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., age, gender, geographical location, publication year, comorbidities, type of surgical procedure). The Egger test and funnel plots will be used to assess small study effects (publication bias).
This systematic review and meta-analysis will identify, evaluate, and integrate the evidence on the incidence, risk factors, and outcomes of early POHG in surgical patients. The results of this study can be used to identify populations which may be at particular risk for POHG. Future studies which use this information to better guide post-operative glycemic control in surgical patients could be considered.
PROSPERO registration number CRD42020167138.
术后早期高血糖（POHG）较为常见，与术后不良结局有关。目前，尚无系统评价和荟萃分析来解决手术患者中 POHG 发生率的知识空白，并探讨相关的危险因素和并发症。本研究的目的是估计全球男性和女性术后早期高血糖（POHG）的总体发生率、危险因素和临床结局。
我们设计并注册了一项系统评价和荟萃分析研究方案，以评估报告术后高血糖（POHG）发生率的研究。我们将搜索 PubMed（MEDLINE）、Scopus、Web of Science、EMBASE、Cochrane 图书馆、OVID（HEALTH STAR）、OVID（MEDLINE）和 Joana Briggs 研究所 EBF 数据库（从成立开始）。将纳入报告 POHG 发生率并在手术患者中进行的随机对照试验和观察性队列研究。不会应用年龄、地理位置、研究设计或语言限制。主要结局将是 POHG 的发生率。次要结局将是 POHG 的危险因素和临床结局。两名审查员将独立筛选引文、全文文章和摘要数据、提取数据，并评估纳入研究的质量和偏倚。通过与第三名研究人员讨论或咨询解决分歧。将使用适当的 Cochrane 随机试验偏倚工具和 Newcastle-Ottawa 量表对纳入研究的风险偏倚和研究方法学质量进行评估。如果可行，我们将进行随机效应荟萃分析，并对比例进行对数转换。我们将报告术后高血糖的概率作为发病率的衡量标准，报告危险因素和术后结局的相对风险比（RR）和 95%置信区间。将进行额外分析以探索潜在的异质性来源（例如，年龄、性别、地理位置、出版年份、合并症、手术类型）。将使用 Egger 检验和漏斗图评估小样本效应（发表偏倚）。
本系统评价和荟萃分析将确定、评估和整合有关手术患者 POHG 发生率、危险因素和结局的证据。本研究的结果可用于识别可能特别容易发生 POHG 的人群。可以考虑未来使用这些信息更好地指导手术患者术后血糖控制的研究。
PROSPERO 注册号 CRD42020167138。
