Association of Metabolic Score for Insulin Resistance with Intraoperative QTc Interval Changes During Laparoscopic...

Preoperative metabolic status may influence cardiac repolarization under anesthesia. This study investigated the relationship between the Metabolic Score for Insulin Resistance (METS-IR) and intraoperative QTc dynamics during laparoscopic sleeve gastrectomy (LSG).

This prospective observational study included 75 patients with severe obesity (body mass index ≥ 40 kg/m²) undergoing LSG. Preoperative METS-IR was calculated from laboratory data. The QT interval, Fridericia-corrected QT interval (QTcF), Tp-e interval, and Tp-e/QT ratio were recorded at baseline (T₀), post-intubation (T₁), pneumoperitoneum-supine (T₂), pneumoperitoneum-reverse Trendelenburg (T₃), and post-extubation (T₄). Associations between METS-IR and ΔQTcF were evaluated using Spearman correlation and mixed-effects modeling. Exploratory ROC analysis evaluated a ≥ 15 ms ΔQTcF response.

The METS-IR-ΔQTcF association was most evident at T₃ (ρ = 0.390, p < 0.001). In the mixed-effects model, the METS-IR × T₃ interaction was significant after adjustment for perioperative covariates (β = 8.13, 95% CI 5.20 to 11.06, p < 0.001); however, the T₃-specific estimate was borderline (β = 0.51, 95% CI - 0.07 to 1.09, p = 0.086), indicating that the association was sensitive to model specification. Exploratory analysis for a ≥ 15 ms ΔQTcF response at T₃ showed modest discrimination (AUC = 0.654, 95% CI 0.527 to 0.780, p = 0.017), with high sensitivity but limited specificity.

In this exploratory cohort of hemodynamically stable patients undergoing uncomplicated LSG, METS-IR was associated with QTcF dynamics, particularly at T₃. However, evidence for the T₃ association varied by model specification, and the findings do not support clinical use of METS-IR.