The Inherent Value of Preoperative Optimization-Absolute and Incremental Reduction in Components of Metabolic Syndrome Can Enhance Recovery and Minimize Perioperative Burden.

BACKGROUND: Metabolic syndrome (MetS) is an amalgamation of medical disorders that ultimately increase patient complications. Factors such as obesity, hypertension, dyslipidemia, and diabetes are associated with this disease complex. OBJECTIVE: To assess the incremental value of improving MetS in relation to clinical outcomes. STUDY DESIGN: Retrospective cohort study. METHODS: Patients undergoing elective spine surgery were isolated and separated into 2 groups: MetS patients (>2 metabolic variables: hypertension, diabetes, obesity, and triglycerides) and nonmetabolic patients (<2 metabolic variables). T tests and χ 2 tests compared differences in patient demographics. Resolution of metabolic factors was incrementally analyzed for their effect on perioperative complications through utilization of logistic regressions. RESULTS: A total of 2,855,517 elective spine patients were included. Of them, 20.1% had MeTS (81.4% two factors, 18.4% three factors, 0.2% four factors). MetS patients were older, less female, and more comorbid (P < 0.001). About 28.8% MetS patients developed more complications such as anemia (9.8% vs 5.9%), device related (3.5% vs 2.9%), neurologic (2.3% vs 1.4%), and bowel issues (9.7% vs 6.8 %; P < 0.05). Controlling for age and procedure invasiveness, having 3 MetS factors increased a patient's likelihood (0.89×) of developing a perioperative complication (P < 0.05), whereas 2 factors had lower odds (0.82). More specifically, patients who were diabetes, obese, and had hypertension had the greatest odds at developing a complication (0.58 [0.58-0.57]) followed by those who had concomitant hypertension, high triglycerides, and were obese (0.55 [0.63-0.48]; all P < 0.001). MetS patients with 2 factors, being obese and having hypertension produced the lowest odds at developing a complication (0.5 [0.61-0.43]; P < 0.001). These MetS patients also had a lower length of stay than those with 3 and 4 (P < 0.001). CONCLUSIONS: Metabolic patients improved in perioperative complications incrementally, demonstrating the utility of efforts to mitigate burden of MetS even if not completely abolished. CLINICAL RELEVANCE: This review contributes to the assessment of MetS optimization in the field of adult spine surgery.

Duke Scholars

Author Peter Passias Orthopaedic Surgery