Population Based Outcomes Associated With Metabolic Syndrome In Patients Undergoing Major Open And Endovascular Arterial Procedures
John M. Denesopolis, III, M.D., John S. Futchko, M.D., Patricia Friedmann, M.S., Issam Koleilat, M.D., Evan C. Lipsitz, M.D., Jeffrey E. Indes, M.D..
Albert Einstein College of Medicine at Montefiore Medical Center, Bronx, NY, USA.
OBJECTIVES: Metabolic Syndrome (MetS) is a constellation of conditions including obesity, hyperlipidemia, hyperglycemia, and hypertension. Several studies have described increased cardiovascular disease and poor perioperative outcomes in MetS patients. We sought to identify the prevalence of MetS in patients undergoing major arterial procedures and identify its effect on perioperative outcomes when compared to a control group consisting of similarly matched patients undergoing repair for hip fracture.
METHODS: Patients in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) vascular modules undergoing endovascular or open surgical repair for carotid stenosis (CS), abdominal aortic aneurysm (AAA), aortoiliac occlusive disease (AIOD), and lower extremity occlusive disease (LEOD) were examined and compared to a control group of hip fracture patients based on a modified MetS criteria (BMI >30, hypertension, and diabetes)1. Outcomes included 30-day cerebrovascular accident (CVA), myocardial infarction (MI), death, and unplanned readmissions.
RESULTS: A total of 40,823 patients undergoing vascular procedures from 2015-2017 and 17,112 patients undergoing hip repair from 2016-2017 were identified. Prevalence in the vascular group of 13.72% compared to 4.63% in hip fractures (p <00001). Dehiscence was seen at higher rates in patients with MetS undergoing EVAR (0.58% vs 0.06, p=0.0003) and endovascular repair of aortoiliac occlusive disease (1.45% vs 0.33%, p=0.01). There were increased incidences of superficial infections (9.75% vs 4.24%, p<0.0001), dehiscence (3.77% vs 1.19%, p=0.0008), and unplanned readmission rate (17.61% vs 10.92%, p=0.002) in patients undergoing open aortoiliac surgery. In MetS patients undergoing open repair of LEOD there were increased rates of postoperative MI (3.77% vs 2.71%, p=0.03), acute renal failure (1.16% vs 0.35%, p<0.0001), superficial infections (7.54% vs 5.4%, p=0.0002), deep wound infections (3.77% vs 2.07%, p=0.0002), dehiscence (2.46% vs 1.24%, p=0.0005), and unplanned readmissions (19.35% vs 14.94%, p=0.0002). There were increased rates of CVA (2.61% vs 1.77%, p=0.02), superficial infections (0.64% vs 0.3%, p=0.03), and unplanned readmissions (8.08% vs 5.69%, p=0.0006) in MetS patients undergoing CEA.
CONCLUSIONS: The prevalence of MetS in vascular patients was nearly 3-fold that of orthopedic controls. Metabolic syndrome had no statistically significant effect on 30 day mortality in major arterial open and endovascular procedures. Metabolic syndrome was associated with a statistically significant increased incidence of postoperative myocardial infarction, cerebrovascular accident, acute renal failure, wound complications, and unplanned readmissions.
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