Dataset Information

Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review.

ABSTRACT:

Background

The ability to preoperatively predict postoperative complication risks is valuable for individual counseling and (post)operative planning, e.g. to select low-risk patients eligible for short stay surgery or those with higher risks requiring special attention. These risks however, are not well established in pituitary surgery.

Methods

We conducted a systematic review of associations between preoperative characteristics and postoperative complications of endoscopic transsphenoidal surgery according to the PRISMA guidelines. Risk of bias was assessed through the QUIPS tool.

Results

In total 23 articles were included, containing 5491 patients (96% pituitary adenoma). There was a wide variety regarding the nature and number of risk factors, definitions, measurement and statistics employed, and overall quality of mainly retrospective studies was low. Consistent significant associations were older age for complications in general, and intraventricular extension for cerebrospinal fluid (CSF) leaks. Associations identified in some but not all studies were younger age, increased BMI, female gender, and learning curve for CSF leaks; increased tumor size for complications in general; and Rathke's cleft cysts for diabetes insipidus. Mortality (incidence rate 1%) was not addressed as a risk factor.

Conclusion

Based on current literature, of low to medium quality, it is not possible to comprehensively quantify risk factors for complications. Nevertheless, older age and intraventricular extension were associated with increased postoperative complications. Future research should aim at prospective data collection, reporting of outcomes, and uniformity of definitions. Only then a proper risk analysis can be performed for endoscopic pituitary surgery.

SUBMITTER: Lobatto DJ

PROVIDER: S-EPMC5767215 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Publications

Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review.

Lobatto Daniel J DJ de Vries Friso F Zamanipoor Najafabadi Amir H AH Pereira Alberto M AM Peul Wilco C WC Vliet Vlieland Thea P M TPM Biermasz Nienke R NR van Furth Wouter R WR

Pituitary 20180201 1

<h4>Background</h4>The ability to preoperatively predict postoperative complication risks is valuable for individual counseling and (post)operative planning, e.g. to select low-risk patients eligible for short stay surgery or those with higher risks requiring special attention. These risks however, are not well established in pituitary surgery.<h4>Methods</h4>We conducted a systematic review of associations between preoperative characteristics and postoperative complications of endoscopic transs ...[more]

PMID: 28916976

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Project description:IntroductionDiabetes has an increasing worldwide prevalence. It is known to be a predisposing factor for postoperative complications. Preoperative glycaemic control strategies should be pursued as glycaemic control could serve as a modifiable risk factor. Glycated haemoglobin (HbA1c), a marker of 3-month average glycaemic control, has been shown in meta-analyses to predict postoperative complications in cardiothoracic, bariatric and orthopaedic surgery. However, there is no meta-analysis in the major abdominal surgery population, in whom morbidity may be higher due to the nature of the surgery. Understanding the association between HbA1c and postoperative complications could help in preoperative risk prognostication, counselling and glycaemic target selection. The aim of this systematic review and meta-analysis is to evaluate all evidence on the association between preoperative HbA1c and postoperative complications in elective major abdominal surgery, and to investigate the threshold HbA1c level before postoperative complication rates increase.Methods and analysisThis review will be performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar and China National Knowledge Infrastructure will be searched for all original studies. Study selection, data extraction, risk of bias and quality assessment will be conducted by two independent reviewers. The primary outcome is the association between preoperative HbA1c and major postoperative complications (Clavien Dindo 3-5), and the secondary outcome is the association between HbA1c and overall postoperative complications. Data management and synthesis will be performed using Microsoft Excel and Stata to derive pool estimates.Ethics and disseminationNo ethics approval is required as only secondary data will be used. Findings will be disseminated through peer-reviewed journals and conference presentations.Prospero registration numberCRD42020167347.

Project description:To determine whether smoking has adverse effects on postoperative complications following spine cervical surgery (PROSPERO 2021: CRD42021269648). We searched PubMed, Embase, Cochrane Library, and Web of Science through 13 July 2021 for cohort and case-control studies that investigated the effect of smoking on postoperative complications after cervical spine surgery. Two researchers independently screened the studies and extracted data according to the selection criteria. The meta-analysis included 43 studies, including 27 case-control studies and 16 cohort studies, with 10,020 patients. Pooled estimates showed that smoking was associated with overall postoperative complications (effect estimate [ES] = 1.99, 95% confidence interval [CI]: 1.62-2.44, p < 0.0001), respiratory complications (ES = 2.70, 95% CI: 1.62-4.49, p < 0.0001), reoperation (ES = 2.06, 95% CI: 1.50-2.81, p < 0.0001), dysphagia (ES = 1.49, 95% CI: 1.06-2.10, p = 0.022), wound infection (ES = 3.21, 95% CI: 1.62-6.36, p = 0.001), and axial neck pain (ES = 1.98, 95% CI: 1.25-3.12, p = 0.003). There were no significant differences between the smoking and nonsmoking groups in terms of fusion (ES = 0.97, 95% CI: 0.94-1.00, p = 0.0097), operation time (weighted mean difference [WMD] = 0.08, 95% CI: -5.54 to 5.71, p = 0.977), estimated blood loss (WMD = -5.31, 95% CI: -148.83 to 139.22, p = 0.943), length of hospital stay (WMD = 1.01, 95% CI: -2.17 to 4.20, p = 0.534), Visual Analog Scale-neck pain score (WMD = -0.19, 95% CI: -1.19 to 0.81, p = 0.707), Visual Analog Scale-arm pain score (WMD = -0.50, 95% CI: -1.53 to 0.53, p = 0.343), Neck Disability Index score (WMD = 11.46, 95% CI: -3.83 to 26.76, p = 0.142), or Japanese Orthopedic Association Scores (WMD = -1.75, 95% CI: -5.27 to 1.78, p = 0.332). Compared with nonsmokers, smokers seem to be more significantly associated with overall complications, respiratory complications, reoperation, longer hospital stay, dysphagia, wound infection and axial neck pain after cervical spine surgery. It is essential to provide timely smoking cessation advice and explanation to patients before elective cervical spine surgery.

Dataset Information

Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review.

Background

Methods

Results

Conclusion

Publications

Preoperative risk factors for postoperative complications in endoscopic pituitary surgery: a systematic review.

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