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Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol.

ABSTRACT: BACKGROUND:Metabolic syndrome (MetS) is defined as an accumulation of risk factors that include chronic hypertension, dyslipidaemia, insulin resistance and obesity and leads to an increased risk for diabetes, cardiovascular disease and stroke. MetS is widespread and estimated to affect up to a quarter of the global population. Patients with MetS who undergo surgery are associated with an increased risk of postoperative complications when compared with patients with a non-MetS profile. An emerging body of literature points to MetS being associated with a greater risk of postoperative pulmonary complications (PPC) in the surgical patient. PPC are associated with increased postoperative morbidity and mortality, Intensive care unit (ICU) admission, length of stay (ICU and hospital), health care costs, resource usage, unplanned re-intubation and prolonged ventilatory time. METHODS/DESIGN:We will search for relevant studies in the following electronic bibliographic databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus as well as scan the reference lists of included studies for potential additional literature. Two authors will independently screen titles and abstracts to identify potentially relevant studies for inclusion based on predefined inclusion and exclusion criteria. The Cochrane Collaboration Review Manager (Review Manager 5) statistical software will be used to conduct this systematic review and meta-analysis and generate forest plots to demonstrate comparison of findings across studies included for meta-analysis. Subgroup and sensitivity analysis will be performed to assess the heterogeneity of included studies. A descriptive synthesis of the statistical data will be provided to summarise the results and findings of the systematic review and meta-analysis. DISCUSSION:This review will be the first to report and summarise the risk for and incidence of PPC in adult patients with MetS undergoing surgery across a range of surgical specialities. The results have the potential to inform the development of evidenced-based interventions to improve the management of PPC in the surgical patient with MetS. Findings from this systematic review and meta-analysis will inform a subsequent Delphi study on priorities and responses to PPC in patients with MetS. We will also disseminate our results through publication in scientific peer-reviewed journals, conference presentations and promotion throughout our network of surgical safety champions in clinical settings. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019120279.

SUBMITTER: Norris P

PROVIDER: S-EPMC6896345 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol.

Norris Philip P Viljoen Bianca B Ralph Nicholas N Gow Jeff J Silvey Natalie N

Systematic reviews 20191206 1

<h4>Background</h4>Metabolic syndrome (MetS) is defined as an accumulation of risk factors that include chronic hypertension, dyslipidaemia, insulin resistance and obesity and leads to an increased risk for diabetes, cardiovascular disease and stroke. MetS is widespread and estimated to affect up to a quarter of the global population. Patients with MetS who undergo surgery are associated with an increased risk of postoperative complications when compared with patients with a non-MetS profile. An ...[more]

PMID: 31810501

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Project description:OBJECTIVE:To identify, appraise, and synthesise the best available evidence on the efficacy of perioperative interventions to reduce postoperative pulmonary complications (PPCs) in adult patients undergoing non-cardiac surgery. DESIGN:Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES:Medline, Embase, CINHAL, and CENTRAL from January 1990 to December 2017. ELIGIBILITY CRITERIA:Randomised controlled trials investigating short term, protocolised medical interventions conducted before, during, or after non-cardiac surgery were included. Trials with clinical diagnostic criteria for PPC outcomes were included. Studies of surgical technique or physiological or biochemical outcomes were excluded. DATA EXTRACTION AND SYNTHESIS:Reviewers independently identified studies, extracted data, and assessed the quality of evidence. Meta-analyses were conducted to calculate risk ratios with 95% confidence intervals. Quality of evidence was summarised in accordance with GRADE methods. The primary outcome was the incidence of PPCs. Secondary outcomes were respiratory infection, atelectasis, length of hospital stay, and mortality. Trial sequential analysis was used to investigate the reliability and conclusiveness of available evidence. Adverse effects of interventions were not measured or compared. RESULTS:117 trials enrolled 21?940 participants, investigating 11 categories of intervention. 95 randomised controlled trials enrolling 18?062 participants were included in meta-analysis; 22 trials were excluded from meta-analysis because the interventions were not sufficiently similar to be pooled. No high quality evidence was found for interventions to reduce the primary outcome (incidence of PPCs). Seven interventions had low or moderate quality evidence with confidence intervals indicating a probable reduction in PPCs: enhanced recovery pathways (risk ratio 0.35, 95% confidence interval 0.21 to 0.58), prophylactic mucolytics (0.40, 0.23 to 0.67), postoperative continuous positive airway pressure ventilation (0.49, 0.24 to 0.99), lung protective intraoperative ventilation (0.52, 0.30 to 0.88), prophylactic respiratory physiotherapy (0.55, 0.32 to 0.93), epidural analgesia (0.77, 0.65 to 0.92), and goal directed haemodynamic therapy (0.87, 0.77 to 0.98). Moderate quality evidence showed no benefit for incentive spirometry in preventing PPCs. Trial sequential analysis adjustment confidently supported a relative risk reduction of 25% in PPCs for prophylactic respiratory physiotherapy, epidural analgesia, enhanced recovery pathways, and goal directed haemodynamic therapies. Insufficient data were available to support or refute equivalent relative risk reductions for other interventions. CONCLUSIONS:Predominantly low quality evidence favours multiple perioperative PPC reduction strategies. Clinicians may choose to reassess their perioperative care pathways, but the results indicate that new trials with a low risk of bias are needed to obtain conclusive evidence of efficacy for many of these interventions. STUDY REGISTRATION:Prospero CRD42016035662.

Project description:BackgroundPostoperative pulmonary complications often lead to increased mortality and financial burden. Residual paralysis plays a critical role in postoperative pulmonary complications. This meta-analysis was performed to determine whether sugammadex overmatches neostigmine in reducing postoperative pulmonary complications.MethodsPubMed, Embase, Web of Science, Medline through Ovid, Cochrane Library, Wanfang, China National Knowledge Infrastructure, and Chinese BioMedical Literature Databases were searched from their inception to 24 June, 2021. Random effects models were used for all analyses. Cochrane risk of bias tool was used to assess the quality of RCTs, while Newcastle Ottawa Quality Assessment Scale was used to assess for the quality of cohort studies.ResultsSeventeen studies were included in the meta-analysis. Pooled data from cohort studies showed reversing neuromuscular blocking with sugammadex had less risk of compound postoperative pulmonary complications (relative risk [RR]: 0.73; 95% confidence interval [CI]: 0.60-0.89; P = 0.002; I2 = 81%), pneumonia (RR: 0.64; 95% CI: 0.48-0.86; I2 = 42%) and respiratory failure (RR: 0.48; 95% CI: 0.41-0.56; I2 = 0%). However, pooled data from RCTs did not show any difference between the two groups in pneumonia (RR: 0.58; 95% CI: 0.24-1.40; I2 = 0%) and no respiratory failure was reported in the included RCTs. The difference was not found between sugammadex and neostigmine about atelectasis in pooled data from either RCTs (RR: 0.85; 95% CI: 0.69-1.05; I2 = 0%) or cohort studies (RR: 1.01; 95% CI: 0.87-1.18; I2 = 0%).ConclusionThe evidence of superiority of sugammadex was limited by the confounding factors in cohort studies and small scale of RCTs. Whether sugammadex precedes neostigmine in preventing pulmonary complications after surgery is still unknown. Well-designed RCTs with large scale are needed.RegistrationPROSPERO ( https://www.crd.york.ac.uk/PROSPERO/ ); CRD 42020191575.

Project description:BackgroundPostoperative pulmonary complications (PPCs) are common after major abdominal surgery. The kinetics of plasma biomarkers could improve identification of patients developing PPCs, but the kinetics may depend on intraoperative ventilator settings.ObjectiveTo test whether the kinetics of plasma biomarkers are capable of identifying patients who will develop PPCs, and whether the kinetics depend on the intraoperative level of positive end-expiratory pressure (PEEP).DesignA preplanned substudy of a randomised controlled trial.SettingOperation room of five centres.PatientsTwo hundred and forty-two adult patients scheduled for abdominal surgery at risk of developing PPCs.InterventionsHigh (12 cmH2O) versus low (≤2 cmH2O) levels of PEEP.Main outcome measuresIndividual PPCs were combined as a composite endpoint. Plasma samples were collected before surgery, directly after surgery and on the fifth postoperative day. The levels of the following were measured: tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-8, the soluble form of the Receptor for Advanced Glycation End-products (sRAGE), Surfactant Protein (SP)-D, Clara Cell protein (CC)-16 and Krebs von den Lungen 6 (KL6).ResultsBlood sampling was complete in 242 patients: 120 patients in the high PEEP group and 122 patients in the low PEEP group. Increases in plasma levels of TNF- IL-6, IL-8 and CC-16, and a decrease in plasma levels of SP-D were greater in patients who developed PPCs; however, the area under the receiver operating characteristic curve was low for all biomarkers. CC-16 was the only biomarker whose level increased more in patients who had received high levels of PEEP.ConclusionIn patients undergoing abdominal surgery and at risk of developing PPCs, plasma levels of biomarkers for inflammation or lung injury showed distinct kinetics with development of PPCs, but none of the biomarkers showed sufficient prognostic value. The use of high levels of PEEP was associated with increased levels of CC-16, suggesting lung overdistension.Trial registrationThe PROVHILO trial, including this substudy, was registered at clinicaltrials.gov (NCT01441791).

Project description:IntroductionTo improve surgical safety, health systems must identify preventable adverse outcomes and measure changes in these outcomes in response to quality improvement initiatives. This requires understanding of the scope and limitations of available population-level data. To derive literature-based summary estimates of benchmarks of care, we will systematically review and meta-analyse rates of postoperative complications associated with several common and/or high-risk operations performed in five high-income countries (HICs).Methods and analysisAn electronic search of PubMed, Embase, Web of Science, Cochrane Central, the NHS Economic Evaluations Database and Health Technology Assessment database will be performed to identify studies reviewing national surgical complication rates between 2000 and 2016. Two reviewers will screen titles and abstracts and full texts of potentially relevant studies to determine eligibility for inclusion in the systematic review. We will include English-language publications using data from health databases in the USA, Canada, the UK, Australia and New Zealand. We will include studies of patients who underwent hip or knee arthoplasty, appendectomy, cholecystectomy, oesophagectomy, abdominal aortic aneurysm repair, aortic valve replacement or coronary artery bypass graft. Outcomes will include mortality, length of hospital stay, pulmonary embolism, pneumonia, sepsis or septic shock, reoperation, surgical site infection, wound dehiscence/disruption, blood transfusion, bile duct injury, stroke and myocardial infarction. We will calculate summary estimates of cumulative incidence, incidence rate, prevalence and occurrence rate of complications using DerSimonian and Laird random effects models. Heterogeneity in these estimates will be examined using subgroup analyses and meta-regression. We will correlate findings within contemporary clinical databases.Ethics and disseminationThis study of secondary data does not require ethics approval. It will be presented internationally and published in the peer-reviewed literature. Results will inform a future quality improvement tool and provide benchmarks of surgical complication rates within HICs.Trial registrationInternational Prospective Register of Systematic Reviews (PROSPERO). Registration number CRD42016037519.

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Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol.

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Risk of postoperative pulmonary complications in adult surgical patients with metabolic syndrome: a systematic review and meta-analysis protocol.

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