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

Abstract

BackgroundMetabolic 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/designWe 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.DiscussionThis 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 registrationPROSPERO CRD42019120279.

Model for predicting early and late-onset postoperative pulmonary complications in perioperative patients receiving neuromuscular blockade: a secondary analysis

“…DM and metabolic syndrome have been widely reported as independent risk factors for an increased risk of POPC in the postoperative stage in previous studies 20 and meta-analyses 21 , 22 .…”

“…It should be noted that many patients with DM have specific neurological and neuromuscular dysfunctions 20 – 22 , though diabetic patients with diagnosed neuropathy were excluded from our study from the start. It has also been shown that subjects with DM and even with prediabetes have reduced respiratory drive under hypoxic conditions, lower forced vital capacity (FVC), lower forced expiratory volume in one second (FEV1), as well as a greater percentage of restrictive spirometric patterns as compared to non-diabetic patients 23 – 25 .…”

In hospital outcomes of autologous and implant‐based breast reconstruction in patients with diabetes mellitus: A population‐based study of 2015–2020 national inpatient sample

“…[20][21][22] DM has also been associated with a higher risk of postoperative pulmonary complications, such as pneumonia, pleural effusions, and atelectasis, which can be attributed to the disruption of both innate and adaptive immunity. 23,24 Furthermore, increased glucose concentrations in the airway surface can promote bacterial proliferation leading to pneumonia. 25 Other surgical complications associated with DM, including excessive scarring in ABR and a higher incidence of hemorrhage/ hematoma in IBR, are also noteworthy for the postoperative management of DM patients.…”

“…Vascular injury, which is common in DM, can lead to postoperative renal complications due to microvascular injury‐related nephropathy 20–22 . DM has also been associated with a higher risk of postoperative pulmonary complications, such as pneumonia, pleural effusions, and atelectasis, which can be attributed to the disruption of both innate and adaptive immunity 23,24 . Furthermore, increased glucose concentrations in the airway surface can promote bacterial proliferation leading to pneumonia 25 .…”

Spine Surgery Patients’ Perceptions of Postoperative Pulmonary Complications

“…Postoperative pulmonary complications (PPCs) including pneumonia, atelectasis, respiratory failure, and exacerbations of underlying chronic lung disease, result in prolonged hospital stays (Murgai et al, 2018). About one in five patients with PPCs die within 30 days of PPC development (Miskovic & Lumb, 2017; Norris et al, 2019; Ramachandran et al, 2011; Smetana, 2009). Respiratory complications are more common in surgeries with extended surgical times, like lumbar spine surgeries (Murgai et al, 2018; Qaseem et al, 2006).…”