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). tests and 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 ( < 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 %; < 0.05). Controlling for age and procedure invasiveness, having 3 MetS factors increased a patient's likelihood (0.89×) of developing a perioperative complication ( < 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 < 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]; < 0.001). These MetS patients also had a lower length of stay than those with 3 and 4 ( < 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.