Evaluating the impact of metabolic syndrome on postoperative thyroidectomy outcomes

Abstract

Objective: Metabolic syndrome (MetS) has previously been linked to increased risk of postoperative morbidity and mortality in other surgical undertakings. Because MetS is a consequence of endocrine dysfunction, and given the thyroid's crucial role in endocrine homeostasis, we sought to evaluate the association between MetS and postoperative outcomes of thyroidectomy. Methods: Data were acquired from the ACS-NSQIP database from years 2005 to 2017. Patients with obesity, diabetes, and hypertension were defined as having MetS. Odds ratios (OR) were obtained for outcomes to quantify risk with multivariate logistic regression. Results: Outcomes significantly affected by MetS included overall complication (OR: 2.00), extended postoperative stay (OR: 1.52), medical complication (OR: 1.48), surgical complication (OR: 1.62), and mortality (OR: 2.33). Conclusions: Patients with MetS undergoing thyroidectomy are at increased risk of an increased length of stay, overall complications, and mortality.

Association between metabolic syndrome and short‐term adverse events in skull base surgery

“…This study's analysis of a large sample demonstrated the significant association between MetS and short‐term postoperative adverse events following skull base surgery. Our results were in line with other studies in the literature that also identified MetS as a risk factor for surgical or medical complications 3–5 . Given that MetS can be a measurable and readily obtainable factor during pre‐ or perioperative assessment, it can provide valuable information for identifying at‐risk patients, optimizing patient counseling and shared decision‐making, and improving postoperative outcomes.…”

“…Patients included those undergoing open or endoscopic skull base surgeries for a variety of anterior, middle, and posterior cranial fossa pathologies, with or without reconstruction. MetS was defined as meeting all of the following three preoperative criteria: hypertension requiring medication, diabetes, and body mass index (BMI) > 30 kg/m 2 3,4 . Complications were categorized as surgical or medical complications according to previous NSQIP studies 7 .…”

“…The prevalence of MetS is continuing to increase in the United States, particularly among young adults 2 . Emerging studies are suggesting an association between MetS and various adverse events following otolaryngologic and neurosurgical surgeries such as thyroidectomy, 3 head and neck microvascular reconstruction, 4 and intracranial tumor resection 5 . This study utilizes a large multicenter hospital‐based database to evaluate associations between MetS and various short‐term adverse events in skull base surgery.…”

Re: Metabolic syndrome and postoperative thyroidectomy outcomes

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We would like to sincerely thank Dr Brož for his interest in our research study and for putting forth concepts that are worthwhile to consider.As mentioned in our paper and the letter sent to the editor, we were limited in establishing the parameters for our definition of metabolic syndrome (MetS). 1 We ultimately resorted to classifying a patient as having MetS if they met all three conditions: (i) in possession of a body mass index ≥30 kg/m 2 , (ii) marked as having hypertension necessitating medical intervention, and (iii) marked as having diabetes mellitus necessitating medical intervention. 2 Dr Brož suggests that this last condition shifts our study population toward a diabetes population as opposed to a true MetS population.

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Metabolic syndrome and postoperative thyroidectomy outcomes

“…To the Editor I read with much interest the paper by Elsamna et al 1 evaluating the impact of metabolic syndrome (MetS) on postoperative thyroidectomy outcomes. The authors analyzed data of 138 318 patients (9321 with MetS) who underwent thyroidectomy and concluded that patients with MetS are at a greater risk of an increased length of postoperative stay, overall complications, and mortality.…”