Zavlin Dmitry, Jubbal Kevin T, Balinger Christopher L, Dinh Tue A, Friedman Jeffrey D, Echo Anthony
Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, 6560 Fannin Street, Scurlock Tower, Suite 2200, Houston, TX, 77030, USA.
Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA.
Aesthetic Plast Surg. 2017 Dec;41(6):1400-1407. doi: 10.1007/s00266-017-0952-6. Epub 2017 Aug 4.
Metabolic syndrome (MetS) is defined as the concomitant disease process of obesity and at least two of the following variables: diabetes, hypertension, hypertriglyceridemia, or reduced high-density lipoprotein. These entities are well established as risk factors for complications following surgery. Obese patients are particularly prone to the development of MetS. The authors therefore aimed at elucidating the impact of MetS on the perioperative panniculectomy outcomes.
The American College of Surgeons National Surgical Quality Improvement Program database was analyzed for all primary procedures of panniculectomy from 2010 through 2015. The cases were stratified based on the presence or absence of MetS and evaluated for demographic data, intraoperative details, and their morbidity and mortality within 30 days after surgery.
A total of 7030 cases were included in this study. Patients with MetS (6.2%) were of significantly worse health, required more emergency admissions (p = 0.022), longer hospitalization (p < 0.001), and more frequently inpatient procedures (p < 0.001) compared to the control group without MetS (3.8%). Plastic surgery was the predominant specialty operating on 79.5% of all cases. Surgical (23.3 vs. 8.7%) complications, readmission (8.7 vs. 3.0%), and reoperations (6.9 vs. 3.1%) rates were all significantly higher in patients with MetS that those without (p < 0.001). One fatality occurred in each cohort (0.23 vs. 0.02%, p = 0.010).
Comorbidities are not uncommon in patients undergoing panniculectomy, especially in those diagnosed with MetS. Health-care providers need to be aware of the increased morbidity and mortality in this high-risk subgroup and need to consider preoperative optimization and management before proceeding with surgery.
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代谢综合征（MetS）被定义为肥胖与以下至少两个变量同时出现的疾病过程：糖尿病、高血压、高甘油三酯血症或高密度脂蛋白降低。这些情况已被确认为手术后并发症的危险因素。肥胖患者尤其容易发生代谢综合征。因此，作者旨在阐明代谢综合征对围手术期腹壁成形术结果的影响。
分析美国外科医师学会国家外科质量改进计划数据库中2010年至2015年所有腹壁成形术的主要手术病例。根据是否存在代谢综合征对病例进行分层，并评估人口统计学数据、术中细节以及术后30天内的发病率和死亡率。
本研究共纳入7030例病例。与无代谢综合征的对照组（3.8%）相比，患有代谢综合征的患者（6.2%）健康状况明显较差，需要更多的急诊入院（p = 0.022）、更长的住院时间（p < 0.001）以及更频繁的住院手术（p < 0.001）。整形外科是所有病例中79.5%的主要手术专科。患有代谢综合征的患者的手术并发症（23.3%对8.7%）、再入院率（8.7%对3.0%）和再次手术率（6.9%对3.1%）均显著高于无代谢综合征的患者（p < 0.001）。每个队列均发生1例死亡（0.23%对0.02%，p = 0.010）。
在接受腹壁成形术的患者中，合并症并不少见，尤其是在诊断为代谢综合征的患者中。医疗保健提供者需要意识到这一高危亚组中发病率和死亡率的增加，并在进行手术前考虑术前优化和管理。
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