Metabolic Syndrome In Patients Undergoing Complex Vascular Procedures And Its Effect On Perioperative Outcomes
John Denesopolis, MD, Patricia Friedman, M.S., Evan Lipsitz, M.D., Jeffrey Indes, M.D..
Montefiore Medical Center - AECOM, Bronx, NY, USA.
OBJECTIVES: Metabolic Syndrome (MetS) is a constellation of conditions including obesity, hyperlipidemia, hyperglycemia, and hypertension and may be associated with poor perioperative outcomes. We sought to identify the prevalence of MetS in patients undergoing complex vascular procedures, and determine if MetS had an effect on outcomes.
METHODS: Patients undergoing endovascular or open repair for 4 vascular pathologies “carotid, abdominal aortic aneurysm (AAA), aortoiliac occlusive (AIOD), and lower extremity occlusive (LEOD)” were examined and compared to similar aged control group of patients undergoing repair for hip fractures. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried, using a modified MetS criteria to identify patients with a BMI >30, hypertension, and diabetes. The primary outcomes included the prevalence of MetS and the composite outcomes of death, stroke (CVA), and myocardial infarction (MI). Secondary outcomes included unplanned readmissions, pneumonia, and sepsis.
RESULTS: There were 40,828 patients undergoing complex vascular procedures between 2015 and 2017 and 17,112 patients undergoing hip repair between 2016 and 2017. The prevalence of MetS in the vascular population was 13.72% compared to 4.63% of hip fractures (p<00001). MetS was not associated with death, stroke or MI for patients undergoing surgery for AIOD (p = 0.95), LEOD (p = 0.71), or AAA (p = 0.97) but was for patients undergoing carotid interventions (p = 0.02). Patients with MetS undergoing open AAA repair had a statistically significant increase in pneumonia and death compared to EVAR patients (p=0.0007 and p=0.002). Patients with MetS undergoing open surgery for AIOD and LEOD had statistically significant more unplanned readmissions compared to MetS patients undergoing endovascular surgery (AIOD p=0.002 and LEOD p=0.0004). No statistically significant differences were seen in the secondary outcomes for patients with MetS undergoing carotid intervention.
CONCLUSIONS: Among patients undergoing complex vascular procedures the prevalence of MetS was nearly 3-fold that of controls. Patients with MetS had increased death, stroke and MI when undergoing carotid intervention. Endovascular repair was associated with less postoperative complications in MetS patients with AAA, AIOD and LEOD.
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