Perioperative outcomes among patients with the modified metabolic syndrome who are undergoing noncardiac surgery.
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.
Glance
Laurent G
LG
Department of Anesthesiology, University of Rochester School of Medicine, Rochester, New York, USA. laurent_glance@urmc.rochester.edu
Wissler
Richard
R
Mukamel
Dana B
DB
Li
Yue
Y
Diachun
Carol Ann B
CA
Salloum
Rabih
R
Fleming
Fergal J
FJ
Dick
Andrew W
AW
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