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자료유형
학술저널
저자정보
Wong Joanna K. L. (Department of Anesthetics Queen’s Hospital) Ke Yuhe (Department of Anesthesiology and Perioperative Medicine Singapore General Hospital) Ong Yi Jing (Department of Medicine National University of Singapore) Li HuiHua (Health Services Research Unit Singapore General Hospital) Wong Ting Hway (Health Services Research Unit Singapore General Hospital) Abdullah Hairil Rizal (Duke-NUS Medical School)
저널정보
대한마취통증의학회(구 대한마취과학회) Korean Journal of Anesthesiology Korean Journal of Anesthesiology Vol.75 No.1
발행연도
2022.2
수록면
47 - 60 (14page)
DOI
10.4097/kja.21295

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Background: Diabetes is a risk factor for postoperative complications. Previous meta-analyses have shown that elevated glycated hemoglobin (HbA1c) levels are associated with postoperative complications in various surgical populations. However, this is the first meta-analysis to investigate the association between preoperative HbA1c levels and postoperative complications in patients undergoing elective major abdominal surgery.Methods: PRISMA guidelines were adhered to for this study. Six databases were searched up to April 1, 2020. Primary studies investigating the effect of HbA1c levels on postoperative complications after elective major abdominal surgery were included. Risk of bias and quality of evidence assessments were performed. Data were pooled using a random effects model. Meta-regression was performed to evaluate different HbA1c cut-off values. Results: Twelve observational studies (25,036 patients) were included. Most studies received a ‘good’ and ‘moderate quality’ score using the NOS and GRADE, respectively. Patients with a high HbA1c had a greater risk of anastomotic leaks (odds ratio [OR]: 2.80, 95% CI [1.63, 4.83], P < 0.001), wound infections (OR: 1.21, 95% CI [1.08, 1.36], P = 0.001), major complications defined as Clavien-Dindo [CD] 3?5 (OR: 2.16, 95% CI [1.54, 3.01], P < 0.001), and overall complications defined as CD 1?5 (OR: 2.12, 95% CI [1.48, 3.04], P < 0.001).Conclusions: An HbA1c between 6% and 7% is associated with higher risks of anastomotic leaks, wound infections, major complications, and overall postoperative complications. Therefore, guidelines with an HbA1c threshold > 7% may be putting pre-optimized patients at risk. Future randomized controlled trials are needed to explore causation before policy changes are made.

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