Abstract
Patients undergoing complex gastrointestinal surgery are at high risk of major postoperative complications (e.g., anastomotic leakage, sepsis), classified as Clavien-Dindo (CD) ≥ IIIa. Identification of preoperative risk factors can lead to the identification of high-risk patients. These risk factors can also be used to design personalized perioperative care. This systematic review focuses on the identification of these factors. The Medline and Embase databases were searched for prospective, retrospective cohort studies and randomized controlled trials investigating the effect of risk factors on the occurrence of major postoperative complications and/or mortality after complex gastrointestinal cancer surgery. Risk of bias was assessed using the Quality in Prognostic Studies tool. The level of evidence was graded based on the number of studies reporting a significant association between risk factors and major complications. A total of 207 eligible studies were retrieved, identifying 33 risk factors for major postoperative complications and 13 preoperative laboratory results associated with postoperative complications. The present systematic review provides a comprehensive overview of preoperative risk factors associated with major postoperative complications. A wide range of risk factors are amenable to actions in perioperative care and prehabilitation programs, which may lead to improved outcomes for high-risk patients. Additionally, the knowledge of this study is important for benchmarking surgical outcomes.
Highlights
Postoperative complications can occur after every type of surgery, and can lead to increased morbidity and mortality, as well as increased hospital length of stay and healthcare costs [1]
This review focuses on the identification of preoperative risk factors for major postoperative complications (CD ! IIIa) after major abdominal surgery with the construction of an intestinal anastomosis, which includes esophagectomy, gastrectomy, and colorectal surgery
An overview of the results reported in these studies on preoperative risk factors associated with major complications (i.e., CD ! IIIa) after major gastrointestinal cancer surgery is shown in Table 2, together with the type of surgery, and the level of evidence graded according to Table 1
Summary
Postoperative complications can occur after every type of surgery, and can lead to increased morbidity and mortality, as well as increased hospital length of stay and healthcare costs [1]. A large number of studies have focused on reducing complications by improving surgical techniques; relatively few have. The latter contributes largely to the avoidance of complications and is responsible for shorter recovery time after surgery, together with less morbidity and increased survival. Some studies have suggested that perioperative care more accurately dictates outcomes and postoperative complications than surgery itself [4]. The period of time before admission is used for screening for medical conditions that can negatively alter the surgical outcome (e.g., smoking and malnutrition). This can be beneficial when the screening focuses on modifiable risk factors, which subsequently can be (partially) reversed (e.g., physical therapy, nutritional support)
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