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Effect of sarcopenia in predicting postoperative mortality in emergency laparotomy: a systematic review and meta-analysis
World Journal of Emergency Surgery ( IF 8 ) Pub Date : 2022-06-25 , DOI: 10.1186/s13017-022-00440-0
Tao-Ran Yang 1 , Kai Luo 1 , Xiao Deng 2, 3 , Le Xu 1 , Ru-Rong Wang 1 , Peng Ji 4
Affiliation  

While emergency laparotomy has been associated with high rates of postoperative mortality and adverse events, preoperative systematic evaluation of patients may improve perioperative outcomes. However, due to the critical condition of the patient and the limited operation time, it is challenging to conduct a comprehensive evaluation. In recent years, sarcopenia is considered a health problem associated with an increased incidence of poor prognosis. This study aimed to investigate the effect of sarcopenia on 30-day mortality and postoperative adverse events in patients undergoing emergency laparotomy. We systematically searched databases including PubMed, Embase, and Cochrane for all studies comparing emergency laparotomy in patients with and without sarcopenia up to March 1, 2022. The primary outcome was of 30-day postoperative mortality. Secondary outcomes were the length of hospital stay, the incidence of adverse events, number of postoperative intensive care unit (ICU) admissions, and ICU length of stay. Study and outcome-specific risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE). A total of 11 eligible studies were included in this study. The results showed that patients with sarcopenia had a higher risk of death 30 days after surgery (OR = 2.42, 95% CI = 1.93–3.05, P < 0.00001). More patients were admitted to ICU after surgery (OR = 1.58, 95% CI = 1.11–2.25, P = 0.01). Both the ICU length of stay (MD = 0.55, 95% CI = 0.05–1.06, P = 0.03) and hospital length of stay (MD = 2.33, 95% CI = 1.33–3.32, P < 0.00001) were longer in the sarcopenia group. The incidence of postoperative complications was also significantly higher in patients with sarcopenia (OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001). In emergency laparotomy, sarcopenia was associated with increased 30-day postoperative mortality. Both the lengths of stay in the ICU and the total length of hospital stay were significantly higher than those in non-sarcopenic patients. Therefore, we concluded that sarcopenia can be used as a tool to identify preoperative high-risk patients, which can be considered to develop new postoperative risk prediction models. Registration number Registered on Prospero with the registration number of CRD42022300132.

中文翻译:

肌肉减少症对预测急诊剖腹手术术后死亡率的影响:系统评价和荟萃分析

虽然紧急剖腹手术与术后死亡率和不良事件的高发生率有关,但对患者进行术前系统评估可能会改善围手术期结果。但由于患者病情危重,手术时间有限,难以进行综合评估。近年来,肌肉减少症被认为是与预后不良发生率增加相关的健康问题。本研究旨在调查肌肉减少症对急诊剖腹手术患者 30 天死亡率和术后不良事件的影响。我们系统地搜索了包括 PubMed、Embase 和 Cochrane 在内的数据库,以查找截至 2022 年 3 月 1 日之前比较有和无肌肉减少症患者的急诊剖腹手术的所有研究。主要结果是术后 30 天死亡率。次要结局是住院时间、不良事件发生率、术后重症监护病房 (ICU) 入院人数和 ICU 住院时间。使用预后研究质量 (QUIPS) 工具评估研究和结果特定的偏倚风险。我们使用推荐、评估、发展和评估分级 (GRADE) 对证据的确定性进行评级。本研究共纳入 11 项符合条件的研究。结果显示,肌肉减少症患者术后 30 天的死亡风险较高(OR = 2.42,95% CI = 1.93-3.05,P < 0.00001)。更多患者在术后入住 ICU(OR = 1.58, 95% CI = 1.11-2.25, P = 0.01)。ICU住院时间(MD = 0.55, 95% CI = 0.05-1.06, P = 0.03)和住院时间(MD = 2.33, 95% CI = 1.33-3.32, P < 0. 00001)在肌肉减少症组中更长。肌肉减少症患者的术后并发症发生率也显着升高(OR = 1.78, 95% CI = 1.41–2.26, P < 0.00001)。在紧急剖腹手术中,肌肉减少症与术后 30 天死亡率增加有关。ICU住院时间和总住院时间均显着高于非肌肉减少患者。因此,我们得出结论,肌肉减少症可以作为识别术前高危患者的工具,可以考虑开发新的术后风险预测模型。注册号在 Prospero 上注册,注册号为 CRD42022300132。41–2.26,P < 0.00001)。在紧急剖腹手术中,肌肉减少症与术后 30 天死亡率增加有关。ICU住院时间和总住院时间均显着高于非肌肉减少患者。因此,我们得出结论,肌肉减少症可以作为识别术前高危患者的工具,可以考虑开发新的术后风险预测模型。注册号在 Prospero 上注册,注册号为 CRD42022300132。41–2.26,P < 0.00001)。在紧急剖腹手术中,肌肉减少症与术后 30 天死亡率增加有关。ICU住院时间和总住院时间均显着高于非肌肉减少患者。因此,我们得出结论,肌肉减少症可以作为识别术前高危患者的工具,可以考虑开发新的术后风险预测模型。注册号在 Prospero 上注册,注册号为 CRD42022300132。我们得出结论,肌肉减少症可以作为识别术前高危患者的工具,可以考虑开发新的术后风险预测模型。注册号在 Prospero 上注册,注册号为 CRD42022300132。我们得出结论,肌肉减少症可以作为识别术前高危患者的工具,可以考虑开发新的术后风险预测模型。注册号在 Prospero 上注册,注册号为 CRD42022300132。
更新日期:2022-06-27
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