Shariq Omair A, Fruth Kristin M, Hanson Kristine T, Cronin Patricia A, Richards Melanie L, Farley David R, Thompson Geoffrey B, Habermann Elizabeth B, McKenzie Travis J
Department of Surgery, Mayo Clinic, Rochester, MN.
Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN.
Surgery. 2018 Jan;163(1):167-175. doi: 10.1016/j.surg.2017.06.023. Epub 2017 Nov 3.
Rates of obesity and metabolic syndrome continue to rise worldwide; however, the impact of metabolic syndrome on outcomes following adrenalectomy has not been described. In this study, we sought to investigate the effects of metabolic syndrome on postoperative 30-day morbidity, mortality, and utilization of hospital resources in a large cohort of patients undergoing elective laparoscopic adrenalectomy.
Patients who underwent laparoscopic adrenalectomy from 2005 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with body mass index ≥30 kg/m who also had diabetes and hypertension requiring medications were defined as having metabolic syndrome. Univariate and multivariable analyses were performed for the outcomes of 30-day mortality/morbidity, major complications, and utilization of hospital resources (prolonged duration of stay ≥3 days and requirement for perioperative blood transfusion).
Of the 3,502 patients included in the study, 395 had metabolic syndrome (11.3%). Patients with metabolic syndrome were older (P < .001) and had a greater percentage of preoperative comorbidities (P < .05) than patients without metabolic syndrome. On unadjusted analysis, metabolic syndrome was associated with an increased risk for mortality/morbidity, major complications, duration of stay, operative time, and risk for blood transfusion (all P < .001). On multivariable analysis, metabolic syndrome was an independent predictor of overall mortality/morbidity (odds ratio, 1.86; P < .001), major complications (odds ratio, 1.99; P < .001), pulmonary complications (odds ratio, 1.83; P = .049), the need for blood transfusion (odds ratio, 1.94; P = .04), and prolonged length of stay (odds ratio odds ratio, 1.34; P = .02).
The presence of metabolic syndrome increased the risk for postoperative complications after laparoscopic adrenalectomy and was associated with 2-fold risk for blood transfusion and 34% increased odds of a prolonged hospital stay.
肥胖和代谢综合征在全球范围内的发病率持续上升；然而，代谢综合征对肾上腺切除术后结局的影响尚未见报道。在本研究中，我们试图调查代谢综合征对接受择期腹腔镜肾上腺切除术的一大群患者术后30天发病率、死亡率及医院资源利用情况的影响。
从美国外科医师学会国家外科质量改进计划数据库中识别出2005年至2014年期间接受腹腔镜肾上腺切除术的患者。体重指数≥30 kg/m²且患有需要药物治疗的糖尿病和高血压的患者被定义为患有代谢综合征。对30天死亡率/发病率、主要并发症及医院资源利用情况（住院时间延长≥3天及围手术期输血需求）的结局进行单因素和多因素分析。
在纳入研究的3502例患者中，395例患有代谢综合征（11.3%）。与无代谢综合征的患者相比，患有代谢综合征的患者年龄更大（P <.001）且术前合并症的比例更高（P <.05）。在未调整分析中，代谢综合征与死亡率/发病率、主要并发症、住院时间、手术时间及输血风险增加相关（所有P <.001）。在多因素分析中，代谢综合征是总体死亡率/发病率（比值比，1.86；P <.001）、主要并发症（比值比，1.99；P <.001）、肺部并发症（比值比，1.83；P =.049）、输血需求（比值比，1.94；P =.04）及住院时间延长（比值比，1.34；P =.02）的独立预测因素。
代谢综合征的存在增加了腹腔镜肾上腺切除术后的并发症风险，并与输血风险增加两倍及住院时间延长几率增加34%相关。
