Modified Metabolic Syndrome Predicts Worse Outcomes in Obese Patients Undergoing Inguinal Hernia Repair
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RESEARCH COMMUNICATION
Modified Metabolic Syndrome Predicts Worse Outcomes in Obese Patients Undergoing Inguinal Hernia Repair Adrienne B. Shannon 1
&
Rachel R. Kelz 2 & Noel N. Williams 3 & Giorgos C. Karakousis 2 & Kristoffel R. Dumon 3
Received: 5 October 2020 / Accepted: 10 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Obesity . Metabolic syndrome . Surgery and obesity . Surgical outcomes . Hernia repair
Introduction Central obesity is a nationwide epidemic with an age-adjusted prevalence of 42.4%.1 Metabolic syndrome (MetS) defines a cluster of diagnostic criteria, including central obesity, insulin resistance, hypertension, and elevated triglycerides, that indicate an increased risk for cardiovascular disease, mortality, and surgical complications and readmission.2–5 Researchers have defined modified metabolic syndrome (mMetS) to analyze outcomes within validated surgical databases as BMI ≥ 30 kg/m2, hypertension, and diagnosis of diabetes mellitus.5,6 Prior studies suggest that MetS may more reliably predict postoperative morbidity compared to its individual components.5,6 The purpose this study was to evaluate the impact of mMetS on perioperative outcomes in patients undergoing elective open inguinal hernia repair.
Materials and Methods Adult patients who underwent open, reducible inguinal hernia repair and had BMI ≥ 18.5 kg/m2 were identified from the 2005–2017 National Surgical Quality Improvement Program database. Patients were divided into cohorts based on presence of mMetS (BMI ≥ 30 kg/m2, hypertension, and diabetes * Adrienne B. Shannon [email protected] 1
Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 5 Silverstein, Philadelphia, PA 19104, USA
2
Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
3
Division of Gastrointestinal Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
mellitus) and then substratified by class of obesity: class I (BMI 30–34.9 kg/m2), II (BMI 35–39.9 kg/m2), and III (BMI ≥ 40 kg/m2). Patient and clinical factors were analyzed using Pearson’s χ2 univariate analyses, and 30-day outcome metrics were analyzed with multivariable logistic regression analyses adjusted for significant covariates. All tests were two-sided and p values < 0.05 were statistically significant.
Results Of 114,957 patients who met inclusion criteria, 2071 (1.8%) patients had mMetS, and 1392 (1.2%), 422 (0.4%), and 257 (0.2%) patients had class I, II, and III obesity, respectively (Table 1). Compared to patients without mMetS, mMetS was significantly associated with 30-day wound infections (1.7% vs 0.4%, odds ratio [OR] 3.26, p < 0.0001), overall morbidity (2.7% vs 0.9%, OR 2.07, p < 0.0001), and readmissions (1.6% vs 0.6%, OR 1.76, p 0.002), with an incremental increase in event odds when stratified by obesity class. There was no difference between the cohorts in all-cause mo
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