Background: Reduced muscle strength- commonly characterized by decreased handgrip strength compared to\r\npopulation norms- is associated with numerous untoward outcomes. Preoperative handgrip strength is a\r\npotentially attractive real-time, non-invasive, cheap and easy-to-perform ââ?¬Å?bedsideââ?¬Â assessment tool. Using\r\nsystematic review procedure, we investigated whether preoperative handgrip strength was associated with\r\npostoperative outcomes in adults undergoing surgery.\r\nMethods: PRISMA and MOOSE consensus guidelines for reporting systematic reviews were followed. MEDLINE,\r\nEMBASE, and the Cochrane Central Register of Controlled Clinical Trials (1980-2010) were systematically searched by\r\ntwo independent reviewers. The selection criteria were limited to include studies of preoperative handgrip strength\r\nin human adults undergoing non-emergency, cardiac and non-cardiac surgery. Study procedural quality was\r\nanalysed using the Newcastle-Ottawa Quality Assessment score. The outcomes assessed were postoperative\r\nmorbidity, mortality and hospital stay.\r\nResults: Nineteen clinical studies (17 prospective; 4 in urgent surgery) comprising 2194 patients were identified\r\nbetween1980-2010. Impaired handgrip strength and postoperative morbidity were defined inconsistently between\r\nstudies. Only 2 studies explicitly ensured investigators collecting postoperative outcomes data were blinded to\r\npreoperative handgrip strength test results. The heterogeneity of study design used and the diversity of surgical\r\nprocedures precluded formal meta-analysis. Despite the moderate quality of these observational studies, lower\r\nhandgrip strength was associated with increased morbidity (n = 10 studies), mortality (n = 2/5 studies) and length\r\nof hospital stay (n = 3/7 studies).\r\nConclusions: Impaired preoperative handgrip strength may be associated with poorer postoperative outcomes,\r\nbut further work exploring its predictive power is warranted using prospectively acquired, objectively defined\r\nmeasures of postoperative morbidity.
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