Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis.
Postoperative short-term mortality between insulin-treated and non-insulin-treated patients with diabetes after non-cardiac surgery: a systematic review and meta-analysis.
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DOI：
10.3389/fmed.2023.1142490
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发表时间：
2023
影响因子：
3.9
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中科院分区：
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糖尿病是术后并发症的独立危险因素。据报道，与心脏手术后非胰岛素治疗的糖尿病患者相比，胰岛素治疗的糖尿病患者术后死亡率增加;然而，尚不清楚这一发现是否适用于非心脏手术。我们的目的是评估胰岛素治疗和非胰岛素治疗的糖尿病对非心脏手术后短期死亡率的影响。我们的研究是对观察性研究的系统回顾和荟萃分析。检索了PubMed、CENTRAL、EMBASE和ISI Web of Science数据库，时间范围为从开始到2021年2月22日。纳入了队列或病例对照研究，这些研究提供了胰岛素治疗的糖尿病患者和非胰岛素治疗的糖尿病患者术后短期死亡率的信息。我们用随机效应模型把数据合并起来。建议、评估、开发和评价系统的分级用于评价证据的质量。纳入了22项队列研究，涉及208，214名受试者。我们的研究表明，接受胰岛素治疗的糖尿病患者的30天死亡率风险高于未接受胰岛素治疗的糖尿病患者[19项研究，197，704例患者，风险比（RR）1.305; 95%置信区间（CI），1.127至1.511; p < 0.001]。这些研究被评为质量极低。在使用修整和填充方法添加7项模拟缺失研究后，新的合并结果仅略有变化（RR，1.260; 95% CI，1.076-1.476; p = 0.004）。我们的研究结果还显示，胰岛素治疗的糖尿病和非胰岛素治疗的糖尿病在住院死亡率方面没有显著差异（两项研究，9，032例患者，RR，0.970; 95%CI，0.584-1.611; p = 0.905）。极低质量的证据表明，胰岛素治疗的糖尿病与非心脏手术后30天死亡率增加有关。然而，由于混杂因素的影响，这一结果是不确定的。https://www.crd.york.ac.uk/prospero/display_record.php? ID= CRD 42021246752，标识符：CRD 42021246752。
Diabetes mellitus is an independent risk factor for postoperative complications. It has been reported that insulin-treated diabetes is associated with increased postoperative mortality compared to non-insulin-treated diabetes after cardiac surgery; however, it is unclear whether this finding is applicable to non-cardiac surgery. We aimed to assess the effects of insulin-treated and non-insulin-treated diabetes on short-term mortality after non-cardiac surgery. Our study was a systematic review and meta-analysis of observational studies. PubMed, CENTRAL, EMBASE, and ISI Web of Science databases were searched from inception to February 22, 2021. Cohort or case-control studies that provided information on postoperative short-term mortality in insulin-treated diabetic and non-insulin-treated diabetic patients were included. We pooled the data with a random-effects model. The Grading of Recommendations, Assessment, Development, and Evaluation system was used to rate the quality of evidence. Twenty-two cohort studies involving 208,214 participants were included. Our study suggested that insulin-treated diabetic patients was associated with a higher risk of 30-day mortality than non-insulin-treated diabetic patients [19 studies with 197,704 patients, risk ratio (RR) 1.305; 95% confidence interval (CI), 1.127 to 1.511; p < 0.001]. The studies were rated as very low quality. The new pooled result only slightly changed after seven simulated missing studies were added using the trim-and-fill method (RR, 1.260; 95% CI, 1.076–1.476; p = 0.004). Our results also showed no significant difference between insulin-treated diabetes and non-insulin-treated diabetes regarding in-hospital mortality (two studies with 9,032 patients, RR, 0.970; 95% CI, 0.584–1.611; p = 0.905). Very-low-quality evidence suggests that insulin-treated diabetes was associated with increased 30-day mortality after non-cardiac surgery. However, this finding is non-definitive because of the influence of confounding factors. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021246752, identifier: CRD42021246752.