Postoperative Acute Chest Syndrome and Vaso-Occlusive Crises Following Cholecystectomy in Patients with Sickle Cell Disease: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Purpose and Rationale: Sickle cell disease (SCD) is one of the most prevalent inherited hemoglobinopathies worldwide, affecting approximately eight million individuals globally. Cholelithiasis develops in up to 70% of patients with SCD due to chronic hemolysis and accelerated bilirubin production, making cholecystectomy one of the most commonly performed surgical procedures in this population. However, the perioperative period poses significant risks for patients with SCD, particularly for the development of acute chest syndrome (ACS) and vaso-occlusive crises (VOC), both of which are potentially life-threatening complications associated with substantial morbidity and mortality. Despite the clinical significance of these complications, no comprehensive quantitative synthesis has systematically evaluated ACS and VOC incidence rates following cholecystectomy in SCD patients, formally assessed sources of heterogeneity, compared the effectiveness of different surgical approaches, or identified modifiable risk factors through advanced statistical modeling. This systematic review and meta-analysis aims to address these critical knowledge gaps. Objectives: The primary objectives are to quantify the pooled incidence of ACS and VOC following cholecystectomy in patients with SCD. Secondary objectives include comparing outcomes between laparoscopic and open cholecystectomy approaches, evaluating the effects of different perioperative transfusion strategies (aggressive exchange transfusion, conservative simple transfusion, or no transfusion), identifying patient-level and procedural-level predictors of complications through meta-regression analysis, and exploring sources of heterogeneity through pre-specified subgroup analyses. Methods: This systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. We will systematically search PubMed/MEDLINE, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar from database inception to the search date without language restrictions. Eligible studies will include randomized controlled trials, prospective and retrospective cohort studies, and case series enrolling patients with confirmed SCD diagnosis undergoing cholecystectomy and reporting ACS or VOC as postoperative outcomes. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2.0 tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. Random-effects meta-analysis using the DerSimonian-Laird method with Freeman-Tukey double arcsine transformation will be employed to pool incidence proportions. Comparative outcomes will be synthesized using pooled odds ratios. Meta-regression will investigate relationships between study-level covariates (including operative time, patient age, and publication year) and complication incidence. Subgroup analyses will stratify results by patient age group, publication era, and study design. Publication bias will be assessed using funnel plots and Kendall's tau correlation test. The certainty of evidence will be evaluated using the GRADE approach. Expected Outcomes: This study will provide pooled estimates of ACS and VOC incidence following cholecystectomy in SCD patients, offering clinicians and healthcare systems quantitative data for perioperative risk stratification and patient counseling. Comparative analyses will inform evidence-based decision-making regarding optimal surgical approach selection. Identification of modifiable risk factors, particularly operative duration and transfusion strategies, will have direct implications for surgical planning and perioperative protocol optimization. The findings will contribute to the development of clinical guidelines and quality improvement initiatives aimed at reducing postoperative complications in this vulnerable patient population. Clinical Implications: The results of this meta-analysis are expected to support contemporary trends toward minimally invasive surgical techniques and emphasize the importance of operative efficiency in reducing perioperative complications. By synthesizing the best available evidence, this study will provide a foundation for optimizing perioperative care protocols for patients with SCD undergoing cholecystectomy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,002 |
| Méta-épidémiologie (sens large) | 0,014 | 0,001 |
| Bibliométrie | 0,003 | 0,025 |
| Études des sciences et des technologies | 0,002 | 0,003 |
| Communication savante | 0,005 | 0,003 |
| Science ouverte | 0,007 | 0,006 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; les deux têtes enseignantes s’accordent sur ce qui est montré ici.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».