title: The Impact of Metabolic Syndrome on 30-Day Complications Following Total Joint Arthroplasty.
abstract: The arthroplasty population increasingly presents with comorbid conditions linked to elevated risk of postsurgical complications. Current quality improvement initiatives require providers to more accurately assess and manage risk presurgically. In this investigation, we assess the effect of metabolic syndrome (MetS), as well as the effect of body mass index (BMI) within MetS, on the risk of complication following hip and knee arthroplasty.
  
  
  
  We queried the American College of Surgeons National Surgical Quality Improvement Program database for total hip or knee arthroplasty cases. Thirty-day rates of Centers for Medicare and Medicaid Services (CMS)-reportable complications, wound complications, and readmissions were compared between patients with and without a diagnosis of MetS using multivariate logistic regression. Arthroplasty cases with a diagnosis of MetS were further stratified according to World Health Organization BMI class, and the role of BMI within the context of MetS was assessed.
  
  
  
  Of the 107,117 included patients, 11,030 (10.3%) had MetS. MetS was significantly associated with CMS complications (odds ratio [OR] = 1.415; 95% confidence interval [CI], 1.306-1.533; P < .001), wound complications (OR = 1.749; 95% CI, 1.482-2.064; P < .001), and readmission (OR = 1.451; 95% CI, 1.314-1.602; P < .001). When MetS was assessed by individual BMI class, the MetS + BMI >40 group was associated with significantly higher risk of CMS complications, wound complications, and readmission compared to the lower MetS BMI groups.
  
  
  
  MetS is an independent risk factor for CMS-reportable complications, wound complications, and readmission following total joint arthroplasty. The risk attributable to MetS exists irrespective of obesity class and increases as BMI increases.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Adam I
authors.initials: AI
authors.lastname: Edelstein
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Francis
authors.initials: F
authors.lastname: Lovecchio
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Dimitri E
authors.initials: DE
authors.lastname: Delagrammaticas
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Fitz
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hardt
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Manning
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D016017:Odds Ratio; D010359:Patient Readmission; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D058996:Quality Improvement; D012307:Risk Factors; D012955:Societies, Medical; D014481:United States
keywords: BMI; TJA; complications; metabolic syndrome; obesity