Which patients are more likely to experience compensatory hyperhidrosis after endoscopic thoracic sympathectomy: a meta-analysis and systematic review.

Background: Compensatory hyperhidrosis (CH) is a common consequence of sympathectomy, which can adversely affect patients' quality of life after surgery. Understanding the factors that influence the occurrence of CH and severe compensatory hyperhidrosis (SCH) is crucial for effective management and counseling of patients undergoing this procedure. Materials and Methods: We registered the protocol in International Prospective Register of Systematic Reviews (CRD42024592389) and following PRISMA guidelines. We searched PubMed, EMBASE, and Web of Science databases for studies published up to September 11, 2024. A systematic literature search identified a total of 10 studies involving 3,117 patients. The primary outcome was the number of CH or SCH. The secondary outcome was the weighted mean difference calculated based on identified related factors. When pooling results or conducting a meta-analysis was not feasible, the study findings were presented in a narrative descriptive format. Results: The overall incidence of CH was found to be 0.62 (95% confidence interval CI [0.51-0.72]), and four studies totaling 1,618 patients regarding the occurrence of severe compensatory hyperhidrosis, the overall incidence of CH was found to be 0.23 (95% CI [0.12-0.34]). Older age, higher body mass index (BMI) and smoking history correlated positively with CH incidence. In addition, higher BMI level is also associated with the occurrence of SCH (1.20 95% CI [1.01-1.39], Conclusion: The findings of this meta-analysis highlight important demographic and lifestyle factors that contribute to the development of CH and SCH following sympathectomy. Older patients, smokers, and those with higher BMI may be at greater risk for these conditions.