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Abstract
Background:
The patient-related factors are considered to have a great impact on surgical outcomes, such as medical conditions and perioperative pharmacotherapy. Among them, perioperative hyperglycemia has become a risk factor that may be modified, and with the help of it, the postoperative morbidity, especially the infectious ones, increased. Nevertheless, there are inconsistent findings on its effects in general in the differing surgical groups.
Objectives:
The objective of this study was to critically assess the impact of already existing medical conditions and pharmacotherapy on the surgical outcomes in adult patients including quantitative meta-analysis of the relationships between perioperative hyperglycemia and postoperative infectious complications, and a narrative synthesis of cardiovascular and metabolic outcomes.
Methods:
The systematic review was done according to PRISMA 2020 recommendations based on PubMed, Scopus, and Web of Science. Studies with adult patients who underwent major surgery were included and reported postoperative complications. The meta-analysis involved six studies that had similar definitions of perioperative hyperglycemia as well as infectious outcomes. A random-effects model (DerSimonian-Laird method) was used to pool odds ratios (ORs) with 95% confidence intervals (CIs) and weighted by the inverse variance. The I2 was used to measure heterogeneity. Other studies assessing cardiovascular, metabolic and pharmacotherapy related outcomes were naratively synthesized.
Results:
1,247 records were identified and 14 studies met the inclusion criteria and 6 studies were included in the meta-analysis. Perioperative hyperglycemia was also found to have a significant impact on postoperative infectious complications, pooled random-effects OR of 2.45 (95% CI 1.89-3.18; p < 0.001). The fixed-effect model yielded similar results (OR = 2.22, 95% CI 1.86–2.65). The heterogeneity was not high (I2 = 15.7%) so the results of the studies were similar. The results were robust as shown by sensitivity analysis. Narrative synthesis showed that pre-existing cardiovascular diseases, metabolic dysregulation, and pharmacotherapy, such as anticoagulants, corticosteroids and immunosuppressive agents were also linked with adverse postoperative outcomes.
Conclusion:
Perioperative hyperglycemia is an important and a consistent predictor of postoperative infectious complications in surgical adult patients. Moreover, pre-existing illnesses and pharmacotherapy also pose an increased risk of surgery. The results indicate the need to consider perioperative risk assessment and optimization, especially glycemic control, in order to enhance the surgical outcomes.