Faculty Collaboration Database

Metabolic Syndrome Is a Significant Predictor of Postoperative Morbidity and Mortality Following Bariatric Surgery. J Gastrointest Surg 2019 Apr;23(4):739-744

Date

11/16/2018

Pubmed ID

30430431

DOI

10.1007/s11605-018-4035-z

Scopus ID

2-s2.0-85056726065 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

INTRODUCTION/PURPOSE: Metabolic syndrome is commonly demonstrated in patients with morbid obesity undergoing bariatric surgery. The purpose of this study was to determine the effect of metabolic syndrome on morbidity and mortality following bariatric surgery.

MATERIALS AND METHODS: The National Surgical Quality Improvement Program (NSQIP) dataset was queried for patients who underwent bariatric surgical procedures between 2012 and 2014. Patient demographics, comorbid conditions, bariatric procedure type, and postoperative complications were analyzed. Metabolic syndrome was defined as having a body mass index > 30 kg/m² in the presence of the comorbid conditions of hypertension and diabetes. Regression analysis was used to determine the relationship between metabolic syndrome and postoperative morbidity and mortality.

RESULTS: During the study interval, 59,404 patients underwent bariatric surgery (Roux-en-Y gastric bypass = 28,263, sleeve gastrectomy = 30,239, revision = 422, and biliopancreatic diversion = 480). The mean body mass index was 45.9 kg/m², and the mean age was 45 years. Of the cohort, 30,104 (50.6%) patients had a diagnosis of hypertension, 16,558 (27.8%) had diabetes mellitus, and 12,803 (21.5%) met the criteria for metabolic syndrome. Patients with metabolic syndrome were more likely to have Roux-en-Y gastric bypass procedure, a history of congestive heart failure, severe COPD, renal failure, and diminished functional status (p < 0.0001). Morbidity was greater for patients with metabolic syndrome (7.5% vs. 5%; p < 0.0001), and patients in this subset also had a 3.2-fold increased risk of mortality (p < 0.0001).

DISCUSSION: Metabolic syndrome is prevalent in patients who undergo bariatric surgery. We have demonstrated that patients with the constellation of comorbid conditions defining metabolic syndrome are at an increased risk of morbidity and mortality following bariatric surgery. Patients and surgeons should be informed of the potential increased risk in this patient population.

Author List

Lak KL, Helm MC, Kindel TL, Gould JC

Authors

Jon Gould MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Tammy Lyn Kindel MD, PhD Associate Professor in the Surgery department at Medical College of Wisconsin
Kathleen L. Lak MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Adult
Bariatric Surgery
Biliopancreatic Diversion
Body Mass Index
Cohort Studies
Comorbidity
Diabetes Mellitus
Female
Gastrectomy
Gastric Bypass
Heart Arrest
Heart Failure
Humans
Hypertension
Male
Metabolic Syndrome
Middle Aged
Morbidity
Mortality
Obesity, Morbid
Postoperative Complications
Postoperative Period
Pulmonary Disease, Chronic Obstructive
Renal Insufficiency
Sepsis
Surgical Wound Infection
Urinary Tract Infections
Ventilator Weaning