title: 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).
  
  
  CONCLUSIONS
  Patients with the modified metabolic syndrome undergoing noncardiac surgery are at substantially higher risk of complications compared with patients of normal weight.
authors.affiliation: Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York, USA. laurent_glance@urmc.rochester.edu
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Richard
authors.initials: R
authors.lastname: Wissler
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: Yue
authors.initials: Y
authors.lastname: Li
authors.forename: Carol Ann B
authors.initials: CA
authors.lastname: Diachun
authors.forename: Rabih
authors.initials: R
authors.lastname: Salloum
authors.forename: Fergal J
authors.initials: FJ
authors.lastname: Fleming
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D009767:Obesity, Morbid / Q000150:complications; D016017:Odds Ratio; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011446:Prospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome