ReviewSurgery in practice and science2022
Acute chest syndrome in post-operative sickle cell disease patients: A systematic review of predisposing factors and interventions.
Review in Surgery in practice and science, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
2 authors.
Funding
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Abstract
Background: Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). ACS can be precipitated by surgery. This review studies the clinical profiles of ACS following abdominal surgeries to identify risk factors and the impact of different interventions. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in Medline, Embase, Cochrane, and Web of Science. The search terms related to "sickle cell disease", "acute chest syndrome", and "abdominal surgery". Two researchers independently assessed studies for eligibility. Data was reported as a thematic qualitative synthesis. Results: Twenty-four articles were included. ACS occurs in 4% to 23% of SCD patients following abdominal surgeries. Conflicting views exist on the link between age and ACS. Sex is not associated with ACS. Most studies found no association between SCD severity and ACS. One study linked severe SCD with a likelihood of serious complications. Two studies found no association between comorbidities and ACS rates and one study found that pulmonary comorbidities were linked to higher rates of postoperative ACS. ACS is associated with postoperative desaturation. Patients developed leukocytosis, sterile blood and sputum cultures and pulmonary infiltrates. Conservative and risk-based transfusions reduce ACS rates. There is no consensus on whether using an open or laparoscopic approach affects the rates of ACS. Conclusion: Conflicting views exist on the correlations between age and comorbidities with ACS. Findings in ACS patients included postoperative desaturation, sterile blood and sputum, and pulmonary infiltrates ipsilateral to the side of the surgery. It has been suggested that postoperative pain may be an early indicator of ACS. Future studies should address the impact of intraoperative complications on postoperative ACS rates. Individualised risk-based transfusions confer benefit. Interventions such as prophylactic cholecystectomies, prophylactic postoperative CPAP, and minimally invasive laparoscopy need further exploration.
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Registered trials
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