BACKGROUND: Patients with metabolic syndrome (MS) may have increased perioperative morbidity and mortality. The aim of this analysis was to investigate the association of MS with mortality, serious morbidity, and pancreatectomy-specific outcomes in patients undergoing pancreatoduodenectomy (PD). METHODS: Patients with MS who underwent PD were selected from the 2014-2018 ACS-NSQIP pancreatectomy-specific database. MS was defined as obesity (BMI ≥ 30 kg/m2), diabetes, and hypertension. Demographics and outcomes were compared by χ2 and Mann-Whitney tests, and adjusted odds ratios from multivariable logistic regression assessed the association between MS and primary outcomes. RESULTS: Of 19,054 patients who underwent PD, 7.3% (n = 1388) had MS. On univariable analysis, patients with MS had significantly worse outcomes (p < 0.05): 30-day mortality (3% vs 1.8%), serious morbidity (26% vs 23%), re-intubation (4.9% vs 3.5%), pulmonary embolism (2.0% vs 1.1%), acute renal failure (1.5% vs 0.9%), cardiac arrest (1.9% vs 1.0%), and delayed gastric emptying (18% vs 16.5%). On multivariable analysis, 30-day mortality was significantly increased in patients with MS (aOR: 1.53, p < 0.01). CONCLUSION: Metabolic syndrome is associated with increased morbidity and mortality in patients undergoing pancreatoduodenectomy. The association with mortality is a novel observation. Perioperative strategies aimed at reduction and/or mitigation of cardiac, pulmonary, thrombotic, and renal complications should be employed in this population given their increased risk.
BACKGROUND: Patients with metabolic syndrome (MS) may have increased perioperative morbidity and mortality. The aim of this analysis was to investigate the association of MS with mortality, serious morbidity, and pancreatectomy-specific outcomes in patients undergoing pancreatoduodenectomy (PD). METHODS: Patients with MS who underwent PD were selected from the 2014-2018 ACS-NSQIP pancreatectomy-specific database. MS was defined as obesity (BMI ≥ 30 kg/m2), diabetes, and hypertension. Demographics and outcomes were compared by χ2 and Mann-Whitney tests, and adjusted odds ratios from multivariable logistic regression assessed the association between MS and primary outcomes. RESULTS: Of 19,054 patients who underwent PD, 7.3% (n = 1388) had MS. On univariable analysis, patients with MS had significantly worse outcomes (p < 0.05): 30-day mortality (3% vs 1.8%), serious morbidity (26% vs 23%), re-intubation (4.9% vs 3.5%), pulmonary embolism (2.0% vs 1.1%), acute renal failure (1.5% vs 0.9%), cardiac arrest (1.9% vs 1.0%), and delayed gastric emptying (18% vs 16.5%). On multivariable analysis, 30-day mortality was significantly increased in patients with MS (aOR: 1.53, p < 0.01). CONCLUSION: Metabolic syndrome is associated with increased morbidity and mortality in patients undergoing pancreatoduodenectomy. The association with mortality is a novel observation. Perioperative strategies aimed at reduction and/or mitigation of cardiac, pulmonary, thrombotic, and renal complications should be employed in this population given their increased risk.
Authors: Omair A Shariq; Kristine T Hanson; Nicholas P McKenna; Scott R Kelley; Eric J Dozois; Amy L Lightner; Kellie L Mathis; Elizabeth B Habermann Journal: Dis Colon Rectum Date: 2019-07 Impact factor: 4.585
Authors: Neil H Bhayani; Omar Hyder; Wayne Frederick; Richard D Schulick; Christopher L Wolgang; Kenzo Hirose; Barish Edil; Joseph M Herman; Michael A Choti; Timothy M Pawlik Journal: Surgery Date: 2012-08 Impact factor: 3.982
Authors: Laurent G Glance; Richard Wissler; Dana B Mukamel; Yue Li; Carol Ann B Diachun; Rabih Salloum; Fergal J Fleming; Andrew W Dick Journal: Anesthesiology Date: 2010-10 Impact factor: 7.892
Authors: Omair A Shariq; Kristin M Fruth; Kristine T Hanson; Patricia A Cronin; Melanie L Richards; David R Farley; Geoffrey B Thompson; Elizabeth B Habermann; Travis J McKenzie Journal: Surgery Date: 2017-11-03 Impact factor: 3.982
Authors: May C Tee; Daniel S Ubl; Elizabeth B Habermann; David M Nagorney; Michael L Kendrick; Michael G Sarr; Mark J Truty; Florencia G Que; Kmarie Reid-Lombardo; Rory L Smoot; Michael B Farnell Journal: J Gastrointest Surg Date: 2015-11-09 Impact factor: 3.452
Authors: Alban Zarzavadjian Le Bian; David Fuks; Sophie Chopinet; Sébastien Gaujoux; Manuela Cesaretti; Renato Costi; Ajay P Belgaumkar; Claude Smadja; Brice Gayet Journal: World J Gastroenterol Date: 2017-05-07 Impact factor: 5.742