Major articleDiabetes mellitus is associated with increased risk of surgical site infections: A meta-analysis of prospective cohort studies
Section snippets
Literature search
We conducted this meta-analysis in accordance with the Meta-Analysis of Observational Studies in Epidemiology guidelines.8 We searched PubMed, Embase, and Web of Science databases up to December 23, 2014, by using the following search terms: diabetes mellitus, impaired glucose tolerance, impaired fasting glucose, glucose metabolism disorders, or insulin resistance in combination with surgical site infections. Reference lists of the retrieved articles were also reviewed. We did not contact
Literature search
The search strategy retrieved 1,266 unique studies. Of these, 1,185 studies were excluded after the first screening based on abstracts or titles, leaving 81 articles for full-text review. After assessing the full-text of the 81 potentially relevant articles, 67 articles were excluded for the reasons listed in Figure 1, leaving 14 studies22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 included for the final analyses.
Study characteristics
Characteristics of the 14 included studies are shown in Table 1. All were
Discussion
From the overall meta-analysis, patients with diabetes are almost twice as likely to develop SSIs when compared with patients without diabetes. The significantly increased risk of SSIs is also detected in the analysis that combines RRa of SSIs for patients with diabetes compared with those without diabetes, although the association becomes slightly weaker. In addition, the association persists and remains statistically significant across a number of stratified analyses exploring clinical and
Conclusions
Our analyses indicate that presence of diabetes is significantly associated with an increased SSI risk. Considering the consistent findings of increased SSI risk associated with diabetes across a number of prospective cohort studies and the reliability and robustness of our meta-analysis, we strongly recommend that future studies focus on the plausible causal mechanisms. Intervention studies concerning perioperative blood glucose control are also warranted to confirm this observed association
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Conflicts of interest: None to report.