title: Metabolic Syndrome is Associated with Increased Postoperative Morbidity and Hospital Resource Utilization in Patients Undergoing Elective Pancreatectomy.
abstract: OBJECTIVE
  In patients undergoing elective partial pancreatectomy, our aim was to evaluate the effect of metabolic syndrome (MS) on postoperative mortality, morbidity, and utilization of hospital resources. Our hypothesis was that MS is associated with worse surgical outcomes after pancreatectomy.
  
  
  METHODS
  Fifteen thousand eight hundred thirty-one patients undergoing elective pancreatectomy from 2005 to 2012 were identified in the Participant User File of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). Univariable and multivariable analyses were performed examining the association of MS (defined as body mass index ≥30 kg/m(2), hypertension requiring medications, and diabetes requiring medications and/or insulin) and risk of 30-day mortality, morbidity, and utilization of hospital resources (risk of blood transfusion in the first 72 h after pancreatectomy and prolonged hospital stay, defined as ≥13 days, which was the 75th percentile of this cohort). Multivariable logistic regression models controlled for age, sex, race, pancreatectomy type (distal versus proximal), smoking status, alcohol consumption, functional status, dyspnea, cardiovascular disease, hematocrit, INR, serum albumin, bilirubin, and creatinine. Stratified analyses were conducted by type of pancreatectomy and indication for pancreatectomy (benign versus malignant).
  
  
  RESULTS
  On univariate analysis, 1070 (6.8%) patients had MS. MS was associated with increased postoperative morbidity, major morbidity, surgical site infection, septic shock, cardiac event, respiratory failure, pulmonary embolism, blood transfusion, and prolonged duration of hospital stay (P < 0.05 for all analyses). After controlling for potentially confounding variables, there was a 26% increased odds of postoperative morbidity (P < 0.001), 17% increased odds of major morbidity (P = 0.034), 32% increased odds of surgical site infection (P < 0.001), 34% increased odds of respiratory failure (P = 0.023), 68% increased odds of pulmonary embolism (P = 0.045), 26% increased odds of blood transfusion (P = 0.018), and 21% increased odds of prolonged hospital stay (P = 0.011) in patients with MS compared to patients without MS. MS was not associated with 30-day mortality after elective pancreatectomy (P = 0.465). When stratified by distal versus proximal pancreatectomy and benign versus malignant disease, the effect of MS on outcomes appears to be modified by type of pancreatectomy and indication with poorer outcomes observed for distal pancreatectomies and benign indications for resection.
  
  
  CONCLUSIONS
  MS is an under-emphasized predictor of increased postoperative morbidity and utilization of hospital resources in patients undergoing elective pancreatectomy. The effect of MS on these postoperative outcomes appears to be more pronounced for patients with benign rather than malignant indications for pancreatectomy and in patients undergoing distal rather than proximal pancreatectomy. These results may inform patient selection, optimization of comorbidities prior to elective pancreatectomy, and strategies for postoperative management.
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: May C
authors.identifier: http://orcid.org/0000-0002-8087-5522
authors.initials: MC
authors.lastname: Tee
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Ubl
authors.affiliation: Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Truty
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Florencia G
authors.initials: FG
authors.lastname: Que
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Kmarie
authors.initials: K
authors.lastname: Reid-Lombardo
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
authors.forename: Rory L
authors.initials: RL
authors.lastname: Smoot
authors.affiliation: Department of Surgery, Division of Subspecialty General Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. mfarnell@mayo.edu.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
mesh_terms: D000368:Aged; D001803:Blood Transfusion; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications; D012307:Risk Factors
keywords: Metabolic syndrome; NSQIP; Pancreatectomy outcomes