The impact of diabetes on postoperative outcomes following hysterectomy: a systematic review and meta-analysis

Abstract

Objective: Although diabetes mellitus (DM) is considered an important prognostic factor for hysterectomy outcomes, the relationship between DM and postoperative complications remains unclear. The aim of this study was to investigate whether DM is associated with an increased risk of complications following hysterectomy.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library for relevant articles published on or before March 15, 2024. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated via random effects meta-analysis. The primary outcome was the risk of complications posthysterectomy, including postoperative infection and hospital readmission. Additionally, we conducted subgroup and sensitivity analyses to explore the main sources of heterogeneity and assess the stability of the results.

Results: A total of 19 cohort studies comprising 375,531 participants met the inclusion criteria. This meta-analysis revealed that DM was significantly associated with postoperative infection (OR 2.01, 95% CI 1.46-2.77). Additionally, DM was significantly associated with low postoperative survival (5 years) (OR 4.43, 95% CI 2.98-6.58), readmission (OR 1.59, 95% CI 1.42-1.79), embolism (OR 1.31, 95% CI 1.18-1.46), renal failure (OR 3.88, 95% CI 2.74-5.51) and reintubation (OR 3.23, 95% CI 1.64-6.35), whereas DM was not associated with an extended length of stay (OR 1.39, 95% CI 0.93-2.10), myocardial infarction (OR 1.86, 95% CI 0.58-5.98) or blood transfusion (OR 1.36, 95% CI 0.88-2.11) in patients following hysterectomy.

Conclusions: DM increases the risk of postoperative infection following hysterectomy. Special attention should be given to diabetic patients to reduce the incidence of complications after hysterectomy.

Keywords: Diabetes mellitus, Hysterectomy, Postoperative complication, infection, Meta-analysis.

Fig.1

Flowchart of the study selection