Effect of metabolic syndrome on perioperative outcomes after liver surgery

A National Surgical Quality Improvement Program (NSQIP) analysis

Neil H. Bhayani, Omar Hyder, Wayne Frederick, Richard D. Schulick, Christopher L. Wolgang, Kenzo Hirose, Barish Edil, Joseph M. Herman, Michael A. Choti, Timothy M. Pawlik

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background: The problem of obesity has risen to epidemic levels in the United States. A subset of patients with obesity will have metabolic syndrome. We sought to examine the impact of metabolic syndrome on the risk of morbidity and mortality among a large cohort of patients who underwent hepatic resection. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent hepatic resection between January 2005 and December 2008 were identified. Data on clinical characteristics, comorbidities, operative details, as well as postoperative complications and mortality were collected and analyzed. Patients with BMI >30 kg/m 2 who also had hypertension and diabetes were defined as having metabolic syndrome. Results: A total of 3,973 patients who underwent a liver resection were identified. Overall mean body mass index was 28 kg/m 2; 31.7% patients were obese (>30 kg/m 2). Of the patients who were obese, 256 (20%) had metabolic syndrome. Patients with metabolic syndrome were less likely to have had a major hepatectomy (≥hemi-hepatectomy, 36% vs 43%; P =.01) but had a greater mean number of red blood cell transfusions (1.6 vs 1; P = .02). The incidence of postoperative complications after hepatectomy was 23%. Patients with metabolic syndrome had a greater risk for reintubation (odds ratio [OR] 1.9; P = .02), >48 hours ventilator dependence (OR 2.0; P =.003), myocardial infarction (OR 5.5; P = .01) and superficial surgical-site infections (OR 1.7; P = .02) compared with nonmetabolic patients. Overall postoperative mortality was 3%. Metabolic syndrome was associated with an increased risk of postoperative death (OR 2.7; P =.001). Conclusion: The presence of metabolic syndrome was associated with a greater risk of perioperative complications. In addition, patients with metabolic syndrome had greater than a 2-fold increased risk of death after hepatic resection.

Original languageEnglish (US)
Pages (from-to)218-226
Number of pages9
JournalSurgery (United States)
Volume152
Issue number2
DOIs
StatePublished - Aug 2012

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Quality Improvement
Liver
Odds Ratio
Hepatectomy
Mortality
Obesity
Surgical Wound Infection
Erythrocyte Transfusion
Mechanical Ventilators
Comorbidity
Body Mass Index
Myocardial Infarction
Hypertension
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Effect of metabolic syndrome on perioperative outcomes after liver surgery : A National Surgical Quality Improvement Program (NSQIP) analysis. / Bhayani, Neil H.; Hyder, Omar; Frederick, Wayne; Schulick, Richard D.; Wolgang, Christopher L.; Hirose, Kenzo; Edil, Barish; Herman, Joseph M.; Choti, Michael A.; Pawlik, Timothy M.

In: Surgery (United States), Vol. 152, No. 2, 08.2012, p. 218-226.

Research output: Contribution to journalArticle

Bhayani, NH, Hyder, O, Frederick, W, Schulick, RD, Wolgang, CL, Hirose, K, Edil, B, Herman, JM, Choti, MA & Pawlik, TM 2012, 'Effect of metabolic syndrome on perioperative outcomes after liver surgery: A National Surgical Quality Improvement Program (NSQIP) analysis', Surgery (United States), vol. 152, no. 2, pp. 218-226. https://doi.org/10.1016/j.surg.2012.05.037
Bhayani, Neil H. ; Hyder, Omar ; Frederick, Wayne ; Schulick, Richard D. ; Wolgang, Christopher L. ; Hirose, Kenzo ; Edil, Barish ; Herman, Joseph M. ; Choti, Michael A. ; Pawlik, Timothy M. / Effect of metabolic syndrome on perioperative outcomes after liver surgery : A National Surgical Quality Improvement Program (NSQIP) analysis. In: Surgery (United States). 2012 ; Vol. 152, No. 2. pp. 218-226.
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abstract = "Background: The problem of obesity has risen to epidemic levels in the United States. A subset of patients with obesity will have metabolic syndrome. We sought to examine the impact of metabolic syndrome on the risk of morbidity and mortality among a large cohort of patients who underwent hepatic resection. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent hepatic resection between January 2005 and December 2008 were identified. Data on clinical characteristics, comorbidities, operative details, as well as postoperative complications and mortality were collected and analyzed. Patients with BMI >30 kg/m 2 who also had hypertension and diabetes were defined as having metabolic syndrome. Results: A total of 3,973 patients who underwent a liver resection were identified. Overall mean body mass index was 28 kg/m 2; 31.7{\%} patients were obese (>30 kg/m 2). Of the patients who were obese, 256 (20{\%}) had metabolic syndrome. Patients with metabolic syndrome were less likely to have had a major hepatectomy (≥hemi-hepatectomy, 36{\%} vs 43{\%}; P =.01) but had a greater mean number of red blood cell transfusions (1.6 vs 1; P = .02). The incidence of postoperative complications after hepatectomy was 23{\%}. Patients with metabolic syndrome had a greater risk for reintubation (odds ratio [OR] 1.9; P = .02), >48 hours ventilator dependence (OR 2.0; P =.003), myocardial infarction (OR 5.5; P = .01) and superficial surgical-site infections (OR 1.7; P = .02) compared with nonmetabolic patients. Overall postoperative mortality was 3{\%}. Metabolic syndrome was associated with an increased risk of postoperative death (OR 2.7; P =.001). Conclusion: The presence of metabolic syndrome was associated with a greater risk of perioperative complications. In addition, patients with metabolic syndrome had greater than a 2-fold increased risk of death after hepatic resection.",
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T1 - Effect of metabolic syndrome on perioperative outcomes after liver surgery

T2 - A National Surgical Quality Improvement Program (NSQIP) analysis

AU - Bhayani, Neil H.

AU - Hyder, Omar

AU - Frederick, Wayne

AU - Schulick, Richard D.

AU - Wolgang, Christopher L.

AU - Hirose, Kenzo

AU - Edil, Barish

AU - Herman, Joseph M.

AU - Choti, Michael A.

AU - Pawlik, Timothy M.

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N2 - Background: The problem of obesity has risen to epidemic levels in the United States. A subset of patients with obesity will have metabolic syndrome. We sought to examine the impact of metabolic syndrome on the risk of morbidity and mortality among a large cohort of patients who underwent hepatic resection. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent hepatic resection between January 2005 and December 2008 were identified. Data on clinical characteristics, comorbidities, operative details, as well as postoperative complications and mortality were collected and analyzed. Patients with BMI >30 kg/m 2 who also had hypertension and diabetes were defined as having metabolic syndrome. Results: A total of 3,973 patients who underwent a liver resection were identified. Overall mean body mass index was 28 kg/m 2; 31.7% patients were obese (>30 kg/m 2). Of the patients who were obese, 256 (20%) had metabolic syndrome. Patients with metabolic syndrome were less likely to have had a major hepatectomy (≥hemi-hepatectomy, 36% vs 43%; P =.01) but had a greater mean number of red blood cell transfusions (1.6 vs 1; P = .02). The incidence of postoperative complications after hepatectomy was 23%. Patients with metabolic syndrome had a greater risk for reintubation (odds ratio [OR] 1.9; P = .02), >48 hours ventilator dependence (OR 2.0; P =.003), myocardial infarction (OR 5.5; P = .01) and superficial surgical-site infections (OR 1.7; P = .02) compared with nonmetabolic patients. Overall postoperative mortality was 3%. Metabolic syndrome was associated with an increased risk of postoperative death (OR 2.7; P =.001). Conclusion: The presence of metabolic syndrome was associated with a greater risk of perioperative complications. In addition, patients with metabolic syndrome had greater than a 2-fold increased risk of death after hepatic resection.

AB - Background: The problem of obesity has risen to epidemic levels in the United States. A subset of patients with obesity will have metabolic syndrome. We sought to examine the impact of metabolic syndrome on the risk of morbidity and mortality among a large cohort of patients who underwent hepatic resection. Methods: Patients included in the National Surgical Quality Improvement Program (NSQIP) dataset who underwent hepatic resection between January 2005 and December 2008 were identified. Data on clinical characteristics, comorbidities, operative details, as well as postoperative complications and mortality were collected and analyzed. Patients with BMI >30 kg/m 2 who also had hypertension and diabetes were defined as having metabolic syndrome. Results: A total of 3,973 patients who underwent a liver resection were identified. Overall mean body mass index was 28 kg/m 2; 31.7% patients were obese (>30 kg/m 2). Of the patients who were obese, 256 (20%) had metabolic syndrome. Patients with metabolic syndrome were less likely to have had a major hepatectomy (≥hemi-hepatectomy, 36% vs 43%; P =.01) but had a greater mean number of red blood cell transfusions (1.6 vs 1; P = .02). The incidence of postoperative complications after hepatectomy was 23%. Patients with metabolic syndrome had a greater risk for reintubation (odds ratio [OR] 1.9; P = .02), >48 hours ventilator dependence (OR 2.0; P =.003), myocardial infarction (OR 5.5; P = .01) and superficial surgical-site infections (OR 1.7; P = .02) compared with nonmetabolic patients. Overall postoperative mortality was 3%. Metabolic syndrome was associated with an increased risk of postoperative death (OR 2.7; P =.001). Conclusion: The presence of metabolic syndrome was associated with a greater risk of perioperative complications. In addition, patients with metabolic syndrome had greater than a 2-fold increased risk of death after hepatic resection.

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