Reudink M, Slooter C D, Janssen L, Lieverse A G, Roumen R M H, Slooter G D
Department of Surgery, Máxima Medical Center, Veldhoven, the Netherlands.
Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands.
Ann Med Surg (Lond). 2021 Nov 3;71:102997. doi: 10.1016/j.amsu.2021.102997. eCollection 2021 Nov.
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.
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).
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).
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.
越来越多的证据表明，代谢综合征（MetS）患者在腹部手术后有不良结局的风险。本研究的目的是调查MetS及术前高血糖作为MetS的一个单独组成部分对结直肠手术后不良结局的影响。
根据PRISMA指南系统地进行了文献综述。纳入标准为评估MetS或术前高血糖与结直肠手术后结局（即任何并发症、定义为Clavien-Dindo分级≥III级的严重并发症、吻合口漏、手术部位感染、死亡率和住院时间）之间关系的观察性研究。
六项研究（246,383例患者）评估了MetS，八项研究（9,534例患者）报告了高血糖情况。各研究中MetS的发病率差异很大，从7%到68%不等。荟萃分析表明，与没有MetS的患者相比，患有MetS的患者更有可能发生严重并发症（风险比1.62，95%置信区间1.01-2.59）。此外，还发现发生任何并发症（风险比1.35，95%置信区间0.91-2.00）、吻合口漏（风险比1.67，95%置信区间0.47-5.93）和死亡率（风险比1.19，95%置信区间1.00-1.43）的风险有增加的非显著趋势。此外，术前高血糖与手术部位感染风险增加相关（风险比1.35，95%置信区间1.01-1.81）。
MetS似乎对结直肠手术后的不良结局有负面影响。由于符合纳入标准的研究较少且存在大量异质性，证据并不确凿。未来的前瞻性观察性研究应提高数量和质量，以验证当前结果。
