代谢综合征患者脊柱融合术后的并发症:系统回顾和Meta分析

Complications after spinal fusion in patients with metabolic syndrome:a systematic review and meta-analysis

目的:代谢综合征对一系列外科手术患者的术后结果有负面影响,然而,目前尚不清楚代谢综合征是否与脊柱融合术后的并发症有关。通过系统回顾和Meta分析评估代谢综合征患者脊柱融合术后并发症的相关风险。方法:综合检索知网、万方、维普、PubMed、OVID和Web of Science数据库,选取有关代谢综合征患者脊柱融合术后并发症的相关研究,相关结果指标包括全因并发症、心血管并发症、肺并发症、手术部位感染、败血症、静脉血栓栓塞事件(包括深静脉血栓和肺栓塞)、尿路感染、术后30 d再入院率、术后30 d再手术率、术后30 d死亡率和住院费用。对11种结果进行数据提取、Meta分析或定性研究系统综述。结果:(1)共纳入8项研究,包括1项前瞻性队列研究和7项回顾性队列研究,涉及283 593例患者,纳入的研究文献总体质量较好;(2)Meta分析结果显示,与非代谢综合征组相比,代谢综合征组全因并发症[RR=1.53,95%CI(1.22,1.93),P=0.000 3]、肺部并发症[RR=1.68,95%CI(1.29,2.17),P <0.000 1]、心血管并发症[RR=2.05,95%CI(1.47,2.87),P <0.000 1]、手术部位感染[RR=1.73,95%CI(1.37,2.20),P <0.000 01]和术后30 d再入院[RR=1.44,95%CI(1.16,1.79),P=0.001]的风险增加;(3)定性数据分析表明,代谢综合征与脊柱融合术住院医疗费用增加有关。结论:代谢综合征增加了脊柱融合术后全因并发症、肺部并发症、心血管并发症、手术部位感染和术后30 d再入院的风险。

OBJECTIVE:Metabolic syndrome has been shown to negatively affect postoperative outcomes across a range of surgical procedures.Howeve r,it is unclear whether metabolic syndrome is also associated with complications following spinal fusion surgery.METHODS:CNKI,Wanfang,VIP,PubMed,OVID and Web of Science databases were comprehensively searched.Studies on postoperative complications of spinal fusion in patients with metabolic syndrome we re selected.Relevant outcome measures included all-cause complications,cardiovascular complications,pulmonary complications,surgical site infection,sepsis,venous thromboembolic events(including deep vein thrombosis and pulmonary embolism),urinary tract infection,30-day postoperative readmission rate,30-day postoperative reoperation rate,30-day postoperative mortality and hospitalization costs.Data were extra cted and meta-analyzed or qualitatively synthesized for 11 kinds of outcomes.RESULTS:(1) Eight studies,containing 1 prospective cohort study and 7 retrospective cohort studies,involving a total of 283 593 patients,were included.The overall quality of the included studies was good.(2) Meta-analysis res ults showed that metabolic syndrome increased the risk of all-cause complications [RR=1.53,95%CI(1.22,1.93),P=0.000 3],pulmonary complications [RR=1.68,95%CI(1.29,2.17),P<0.000 1],cardiac complications [RR=2.05,95%CI(1.47,2.87),P<0.000 1],surgical site infection [RR=1.73,95%CI(1.37,2.20),P <0.000 01],and 30-day readmission [RR=1.44,95%CI(1.16,1.79),P=0.001] compared with the non-metabolic syndrome.(3) Qualitative analysis suggested that metabolic syndrome was associated with increased medical costs.CONCLUSION:Metabolic syndrome patients are at increased risk of all-cause complications,pulmonary complications,cardiovascular complications,surgical site infection,and 30-day readmission after spinal fusion surgery.