Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, Texas.
Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California.
Surg Obes Relat Dis. 2018 Feb;14(2):206-213. doi: 10.1016/j.soard.2017.09.521. Epub 2017 Sep 22.
Metabolic syndrome (MetS) entails the simultaneous presence of a constellation of dangerous risk factors including obesity, diabetes, hypertension, and dyslipidemia. The prevalence of MetS in Western society continues to rise and implies an elevated risk for surgical complications and/or poor surgical outcomes within the affected population.
To assess the risks and outcomes of multi-morbid patients with MetS undergoing open ventral hernia repair.
Multi-institutional case-control study in the United States.
The American College of Surgeons National Surgical Quality Improvement Program database was sampled for patients undergoing initial open ventral hernia repair from 2012 through 2014 and then stratified into 2 cohorts based on the presence or absence of MetS. Statistical analyses were performed to evaluate preoperative co-morbidities, intraoperative details, and postoperative morbidity and mortality to identify risk factors for adverse outcomes.
Mean age (61.0 versus 56.0 yr, P<.001), body mass index (39.2 versus 31.1, P<.001), and prevalence of co-morbidities of multiple organ systems were significantly higher (P<.001) in the MetS cohort compared to control. Patients with MetS received higher American Society of Anesthesiologists classifications (81.0% versus 43.1% class 3 or higher, P<.001), were more likely to require operation as emergency cases (11.4% versus 7.2%, P<.001), required longer operative times (103 versus 87 min, P<.001), had longer hospitalizations (3.5 versus 2.4 d, P<.001), and had more contaminated wounds (15.9% versus 12.0% class 2 or higher, P<.001). Overall, they had more medical (7.5% versus 4.2%, P<.001), and surgical complications (9.7% versus 5.4%, P<.001), experienced more readmissions (8.3% versus 5.7%, P<.001) and reoperations (3.4% versus 2.5%, P<.001), and were at higher risk for eventual death (.8% versus .5%, P=.008).
The presence of MetS is related to a multitude of unfavorable outcomes and increased mortality after open ventral hernia repair compared with a non-MetS control group. MetS is a useful marker for high operative risk in a population that is generally prone to obesity and its associated diseases.
代谢综合征（MetS）涉及一系列危险风险因素的同时存在，包括肥胖、糖尿病、高血压和血脂异常。代谢综合征在西方社会的患病率持续上升，这意味着在受影响人群中，手术并发症和/或不良手术结果的风险增加。
评估患有代谢综合征的多合并症患者行开放性腹疝修补术的风险和结果。
美国多机构病例对照研究。
从 2012 年至 2014 年，美国外科医师学院国家外科质量改进计划数据库中抽取了接受初次开放性腹疝修补术的患者，并根据是否存在代谢综合征将其分为 2 个队列。进行统计分析以评估术前合并症、术中细节以及术后发病率和死亡率，以确定不良结果的危险因素。
与对照组相比，代谢综合征组的平均年龄（61.0 岁与 56.0 岁，P<.001）、体重指数（39.2 与 31.1，P<.001）和多器官系统合并症的患病率显著更高（P<.001）。代谢综合征组的患者接受了更高的美国麻醉医师协会分类（81.0%与 43.1%为 3 级或更高级别，P<.001），更有可能需要作为急症手术（11.4%与 7.2%，P<.001），需要更长的手术时间（103 分钟与 87 分钟，P<.001），住院时间更长（3.5 天与 2.4 天，P<.001），并且污染伤口更多（15.9%与 12.0%为 2 级或更高，P<.001）。总体而言，他们的医疗并发症更多（7.5%与 4.2%，P<.001），手术并发症更多（9.7%与 5.4%，P<.001），再入院率更高（8.3%与 5.7%，P<.001）和再次手术率更高（3.4%与 2.5%，P<.001），最终死亡风险更高（0.8%与 0.5%，P=.008）。
与非代谢综合征对照组相比，患有代谢综合征的患者在开放性腹疝修补术后存在多种不良结局和更高的死亡率。代谢综合征是一个有用的标志物，用于评估肥胖及其相关疾病高发人群的高手术风险。
