title: Diabetes and risk of anastomotic leakage after gastrointestinal surgery.
abstract: BACKGROUND
  Anastomotic leakage (AL) is one of the most common and lethal complications in gastrointestinal surgery. However, the relationship between AL risk and diabetes mellitus (DM) remains ambiguous. This meta-analysis was to evaluate the association between DM and AL risk in patients after gastrointestinal resection.
  
  
  METHODS
  Odds ratios (OR) estimate with their corresponding 95% confidence intervals (CIs) were combined and weighted to produce pooled OR using the fixed-effects model. Relative risks were calculated in subgroup analysis of prospective studies. We calculated publication bias by Begg rank correlation test and Egger linear regression test.
  
  
  RESULTS
  DM was significantly and independently associated with an increased risk of AL morbidity in colorectal patients, 1.661 times in total patients (95% CIs = 1.266-2.178), 1.995 times in a subgroup of case-control studies, 1.581 times in cohort investigations, 1.688 times in retrospective trials, and 1.562 times in prospective designs. After adjusting for the factor of obesity and/or body mass index in the subgroup analyses of colorectal surgery, DM patients without obesity experienced a significantly increased risk of AL (OR = 1.572, 95% CIs = 1.112-2.222). Furthermore, when obesity had not been adjusted, DM patients endured a dramatical increase of AL incidence (OR = 1.812, 95% CIs = 1.171-2.804). Perforation incidence after gastric resection showed borderline association with DM (OR = 2.170, 95% CIs = 0.956-4.926).
  
  
  CONCLUSIONS
  The present meta-analysis provides strong evidence for the first time that DM is significantly and independently associated with an increased risk of AL mortality in colorectal surgery.
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Xiaoti
authors.initials: X
authors.lastname: Lin
authors.affiliation: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China; Department of Ophthalmology, Xiangyang Central Hospital, Teaching Hospital of Medical College of Hubei University of Arts and Science, Hubei, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Physiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Weiyu
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Emergency, Fujian Provincial 2(nd) People's Hospital, Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.
authors.forename: Fengqin
authors.initials: F
authors.lastname: Wei
authors.affiliation: Department of Surgery, Fujian Provincial Tumor Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Mingang
authors.initials: M
authors.lastname: Ying
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
authors.forename: Weidong
authors.initials: W
authors.lastname: Wei
authors.affiliation: Department of Breast Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China. Electronic address: xiexiaoming001@gmail.com.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Xie
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology*; D048909:Diabetes Complications / Q000209:etiology*; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D009765:Obesity / Q000150:complications*; D064887:Observational Studies as Topic; D011183:Postoperative Complications / Q000209:etiology*
keywords: Anastomotic leak; Diabetes; Meta-analysis; Peptic disease; Surgery