Abby Yu, Quynh Truong, Karen Whitfield, Andrew Hale, Meng-Wong Taing, Natalie Barker, Michael D’Emden
{"title":"接受非心脏大手术的成人术前血红蛋白 A1c 水平对术后结果的影响：系统综述。","authors":"Abby Yu, Quynh Truong, Karen Whitfield, Andrew Hale, Meng-Wong Taing, Natalie Barker, Michael D’Emden","doi":"10.1111/dme.15380","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA<sub>1c</sub> levels on postoperative outcomes in adults who had undergone major noncardiac surgery.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA<sub>1c</sub> within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA<sub>1c</sub> as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946).</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA<sub>1c</sub> levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA<sub>1c</sub> was associated with increased odds of these complications. No association with reoperations and 30-day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Current evidence suggested that higher preoperative HbA<sub>1c</sub> levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high-quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes.</p>\n </section>\n </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15380","citationCount":"0","resultStr":"{\"title\":\"Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review\",\"authors\":\"Abby Yu, Quynh Truong, Karen Whitfield, Andrew Hale, Meng-Wong Taing, Natalie Barker, Michael D’Emden\",\"doi\":\"10.1111/dme.15380\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA<sub>1c</sub> levels on postoperative outcomes in adults who had undergone major noncardiac surgery.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA<sub>1c</sub> within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA<sub>1c</sub> as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA<sub>1c</sub> levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA<sub>1c</sub> was associated with increased odds of these complications. No association with reoperations and 30-day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Current evidence suggested that higher preoperative HbA<sub>1c</sub> levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. 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Impact of preoperative haemoglobin A1c levels on postoperative outcomes in adults undergoing major noncardiac surgery: A systematic review
Aims
Diabetes is known to increase morbidity and mortality after major surgery. However, literature is conflicting on whether elevated preoperative haemoglobin A1c (HbA1c) levels are associated with worse outcomes following major noncardiac surgery. We aimed to investigate the effect of incremental preoperative HbA1c levels on postoperative outcomes in adults who had undergone major noncardiac surgery.
Methods
We systematically searched PubMed, EMBASE and the Cochrane Library databases for eligible studies published between January 2012 and July 2023. Randomised controlled trials and observational studies (cohort and case–control studies) which measured HbA1c within 6 months before surgery and compared outcomes between at least three incremental subgroups or analysed HbA1c as a continuous variable were included. The systematic review protocol was registered with PROSPERO (CRD42023391946).
Results
Twenty observational studies investigating outcomes across multiple surgical types were included. Higher preoperative HbA1c levels were associated with increased odds of overall postoperative complications, postoperative acute kidney injury, anastomotic leak, surgical site infections and increased length of stay. Each 1% increase in preoperative HbA1c was associated with increased odds of these complications. No association with reoperations and 30-day mortality was identified. The literature was highly variable with respect to composite major complications, perioperative cardiovascular events, hospital readmissions, postoperative pneumonia and systemic thromboembolism.
Conclusions
Current evidence suggested that higher preoperative HbA1c levels were associated with increased odds of postoperative complications and extended length of stay in adults undergoing major noncardiac surgery. Further high-quality studies would be needed to quantify the risks posed and determine whether early intervention improves outcomes.
期刊介绍：
Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions.
The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed.
We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services.
Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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