Metabolic Syndrome Is Associated With Higher Risk of Wound Complications After Total Hip Arthroplasty

Abstract

Background: Obesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty. Methods: Among 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI 30 mg/kg 2), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay. Results: Patients' mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome (P ¼ .16). Conclusions: Metabolic syndrome, but not obesity, defined by a BMI 30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

“…The Xie et al study, which analyzed the impact of MetS on post-operative outcomes after ankle fracture, observed differences that approached statistical significance (p = .054), but ultimately fell short [8]. Conversely, Cheng et al found no significant differences (p = 0.70) in operative time for MetS and non-MetS patients undergoing total hip arthroplasty [7]. This finding is subject to scrutiny, given that fracture classification is not an available variable in the ACS-NSQIP study.…”

“…Conversely, Cheng et al. found no significant differences (p = 0.70) in operative time for MetS and non-MetS patients undergoing total hip arthroplasty [ 7 ]. This finding is subject to scrutiny, given that fracture classification is not an available variable in the ACS-NSQIP study.…”

“…Studies have shown patients with MetS experience increased morbidity and mortality when compared to other patients suffering from various medical conditions and undergoing common surgical procedures, such as thyroidectomy or emergency appendectomy [3][4][5][6]. Furthermore, there is an emerging branch of literature linking MetS to worsened surgical outcomes within orthopaedics and several studies demonstrate patients with MetS to have increased readmissions and complications in the 30-day period following open reduction and internal fixation (ORIF) for ankle fracture as well as increased rates of wound complication after hip arthroplasty [7,8]. Components of MetS, such as type 2 diabetes, are known to increase fracture and infection risk and to adversely affect orthopaedic surgical outcomes through various pathways [6,[9][10][11][12].…”

Total Hip Arthroplasty Outcomes in Patients with Gout: A Retrospective Analysis of Matched Large Cohorts

“…It is worth noting that wound complications remain elevated in gout patients after controlling for numerous gout-associated comorbidities, such as obesity and peripheral arterial disease, which are associated with interrupted tissue healing. 2 24) Additionally, in an animal study, rats with an artificially induced gouty ulcer, when compared with the control group, demonstrated delayed wound healing with associated signs of chronic MSU crystal deposition, tophi ulceration, and chronic inflammatory responses. 25) …”

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

“…Prior studies have evaluated the association between metabolic syndrome and postoperative complications following orthopedic surgeries. Cheng et al found a four-fold increased risk of postoperative wound infection following total hip arthroplasty in patients with metabolic syndrome [ 5 ]. A systematic review and meta-analysis by Guofeng et al found that metabolic syndrome was associated with a higher risk of cardiovascular complications, surgical site infections, urinary tract infections, and 30-day readmission following total hip and total knee arthroplasty [ 6 ].…”