Perioperative Outcomes among Patients with the Modified Metabolic Syndrome Who Are Undergoing Noncardiac Surgery

Abstract

Background:Previous studies have demonstrated that obesity is paradoxically associated with a lower risk of mortality after noncardiac surgery. This study will determine the impact of the modified metabolic syndrome (defined as the presence of obesity, hypertension, and diabetes) on perioperative outcomes. Methods: This study is based on data from 310,208 patients in the American College of Surgeons National Surgical Quality Improvement Program database. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results: Patients with the modified metabolic syndrome who are super obese had a 2-fold increased risk of death (adjusted odds ratio [AOR] 1.99; 95% CI 1.41-2.80). As stratified by body mass index, patients with the modified metabolic syndrome had a 2-to 2.5-fold higher risk of cardiac adverse events (CAE) compared with normal-weight patients: obese (AOR 1.70; 95% CI 1.40 -2.07), morbidly obese (AOR 2.01; 95% CI 1.48 -2.73), and super obese (AOR 2.66; 95% CI 1.68 -4.19). In addition, the risk of acute kidney injury (AKI) was 3-to 7-fold higher in these patients: obese (AOR 3.30; 95% CI 2.75-3.94), morbidly obese (AOR 5.01; 95% CI 3.87-6.49), and super obese (AOR 7.29; 95% CI 5.27-10.1). Conclusion:Patients with the modified metabolic syndrome undergoing noncardiac surgery are at substantially higher risk of complications compared with patients of normal weight.

Acute kidney injury following total joint arthroplasty: retrospective analysis

“…6,7 Two large published studies that examined AKI following general surgery using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were also used to identify potential explanatory variables. 15,16 Generally, age, sex, preexisting renal disease, components of the metabolic syndrome, cardiovascular disease, and surgical complexity have been evaluated. 6,7,15,16 As age and sex were matching criteria and preexisting kidney disease an exclusion criteria, these variables were not examined in this study.…”

“…15,16 Generally, age, sex, preexisting renal disease, components of the metabolic syndrome, cardiovascular disease, and surgical complexity have been evaluated. 6,7,15,16 As age and sex were matching criteria and preexisting kidney disease an exclusion criteria, these variables were not examined in this study. Findings from the logistic regression analyses are summarized by presenting the odds ratios and corresponding 95% confidence intervals.…”

“…A large study of over 300,000 patients undergoing noncardiac surgery from the ACS-NSQIP database found that the risk of postoperative AKI was increased by three-to seven-fold in obese compared with normal-weight patients. 15 Obesity is linked to metabolic syndrome, 25 a condition associated with chronic kidney disease. 17 While the presence of metabolic syndrome was not assessed directly, it is plausible that syndrome components (diabetes, hypertension, hyperlipidemia, glucose intolerance, or insulin resistance) may have acted in concert to increase risk, though parsing the relevance of individual factors is challenging.…”

A Comparative Study between Protective Lung Ventilation versus Conventional Ventilation in Obese Patients Undergoing Abdominal Laparoscopic Surgery

“…The majority of obese patients presenting for surgery are relatively healthy and their perioperative risk is similar to that of normal weight patients. The patients at high risk of perioperative complications are those with central obesity and metabolic syndrome rather than those with isolated extreme obesity [14]. The number of surgical patients with obesity is increasing; and facing these challenges is common in the operating rooms and critical care units worldwide .While lung protective ventilation with low tidal volumes (VT) and the use of positive end-expiratory pressure (PEEP) and recruitment maneuver are now considered routine for ICU patients, the implementation of protective ventilation strategies in the operating room is not widespread [4,15].…”

Peri-operative management of the obese surgical patient 2015

“…The patients at high risk of peri‐operative complications are those with central obesity and metabolic syndrome, rather than those with isolated extreme obesity 10.…”