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Pancreatoduodenectomy: the Metabolic Syndrome is Associated with Preventable Morbidity and Mortality
Victor P Gazivoda1, Alissa Greenbaum1, Matthew A Beier2
1Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA.
Background:
Patients with metabolic syndrome (MS) may have increased perioperative morbidity and mortality. The aim of this analysis was to investigate the association of MS with mortality, serious morbidity, and pancreatectomy-specific outcomes in patients undergoing pancreatoduodenectomy (PD).
Methods:
Patients with MS who underwent PD were selected from the 2014-2018 ACS-NSQIP pancreatectomy-specific database. MS was defined as obesity (BMI ≥ 30 kg/m2), diabetes, and hypertension. Demographics and outcomes were compared by χ2 and Mann-Whitney tests, and adjusted odds ratios from multivariable logistic regression assessed the association between MS and primary outcomes.
Results:
Of 19,054 patients who underwent PD, 7.3% (n = 1388) had MS. On univariable analysis, patients with MS had significantly worse outcomes (p < 0.05): 30-day mortality (3% vs 1.8%), serious morbidity (26% vs 23%), re-intubation (4.9% vs 3.5%), pulmonary embolism (2.0% vs 1.1%), acute renal failure (1.5% vs 0.9%), cardiac arrest (1.9% vs 1.0%), and delayed gastric emptying (18% vs 16.5%). On multivariable analysis, 30-day mortality was significantly increased in patients with MS (aOR: 1.53, p < 0.01).
Conclusion:
Metabolic syndrome is associated with increased morbidity and mortality in patients undergoing pancreatoduodenectomy. The association with mortality is a novel observation. Perioperative strategies aimed at reduction and/or mitigation of cardiac, pulmonary, thrombotic, and renal complications should be employed in this population given their increased risk.
Insights
Metabolic syndrome (MS) significantly increases mortality and serious morbidity in patients undergoing pancreatoduodenectomy (PD). This study highlights the need for targeted perioperative strategies to mitigate risks in patients with MS.
Area of Science:
- Surgical Outcomes
- Metabolic Disorders
- Public Health
Background:
- Metabolic syndrome (MS) is a cluster of conditions including obesity, diabetes, and hypertension.
- MS is associated with increased perioperative risks in surgical patients.
- Pancreatoduodenectomy (PD) is a complex surgical procedure with significant potential for complications.
Purpose of the Study:
- To investigate the association between MS and mortality after PD.
- To assess the impact of MS on serious morbidity following PD.
- To evaluate pancreatectomy-specific outcomes in patients with MS.
Main Methods:
- Analysis of the 2014-2018 ACS-NSQIP pancreatectomy-specific database.
- Inclusion of patients who underwent PD, with MS defined by obesity, diabetes, and hypertension.
- Comparison of outcomes using statistical tests and multivariable logistic regression to determine adjusted odds ratios.
Main Results:
- 7.3% of 19,054 PD patients had MS, exhibiting significantly worse outcomes on univariable analysis.
- Patients with MS showed higher rates of 30-day mortality, serious morbidity, re-intubation, pulmonary embolism, acute renal failure, and cardiac arrest.
- Multivariable analysis confirmed a significant increase in 30-day mortality for patients with MS (aOR: 1.53, p < 0.01).
Conclusions:
- Metabolic syndrome is a significant risk factor for increased morbidity and mortality after pancreatoduodenectomy.
- The association between MS and mortality following PD is a novel finding.
- Proactive perioperative management focusing on cardiac, pulmonary, thrombotic, and renal complications is crucial for MS patients undergoing PD.
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