Postoperative Acute Chest Syndrome and Vaso-Occlusive Crises Following Cholecystectomy in Patients with Sickle Cell Disease: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.014 | 0.001 |
| Bibliometrics | 0.003 | 0.025 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.007 | 0.006 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".