Metabolic syndrome is associated with increased postoperative complications and use of hospital resources in patients undergoing laparoscopic adrenalectomy

Shariq, Omair A.; Fruth, Kristin M.; Hanson, Kristine T.; Cronin, Patricia A.; Richards, Melanie L.; Farley, David R.; Thompson, Geoffrey B.; Habermann, Elizabeth B.; McKenzie, Travis J.

doi:10.1016/j.surg.2017.06.023

Cited by 24 publications

(26 citation statements)

References 23 publications

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“…Hypertension and diabetes were most common comorbidities in our cohort. Previous studies had reported that hypertension and diabetes were associated with the need for perioperative blood transfusion [20,21]. We hypothesized that higher blood pressure and sclerous vessels may cause more blood loss perioperatively.…”

Section: Discussionmentioning

confidence: 94%

A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

Zhang

Liu

et al. 2019

Urol Int

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Purpose: To define preoperative predictors and construct a preoperative multivariable model for prediction of postoperative complications in patients with renal cell carcinoma (RCC) after nephrectomy with thrombectomy. Materials and Methods: We identified patients with RCC and level I–IV venous tumor thrombus (VTT) who underwent concomitant radical nephrectomy and thrombectomy between February 2015 and March 2018. Univariate and multivariate logistic regression analyses were used to assess the effect of preoperative factors on the incidence of overall and major postoperative complications within 30 days postoperatively. A nomogram for prediction of postoperative complications was also developed using regression coefficients from the multivariable analyses. Results: A total of 120 patients met inclusion criteria. We reported an overall complication rate of 39.2% and major complication rate of 12.5% within 30 days after surgery, with perioperative mortality rate of 2.5%. On multivariate analysis, independent predictors of overall complications included systemic symptoms, comorbidity, level III/IV VTT and serum creatine (SCr) level, while only SCr level was significantly associated with major complications. The internal validation result showed that the accuracy of our preoperative nomogram for overall complications measured by c-index was 0.794. Conclusions: We constructed an accurate preoperative model to predict overall postoperative complications in patients with level I–IV thrombus. External verification is still needed to evaluate its general application.

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Section: Discussionmentioning

confidence: 94%

A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

Zhang

Liu

et al. 2019

Urol Int

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“…Obesity is a state in which excess body fat has been stored. The number of obese individuals has progressively increased worldwide [1,2]. In Spain, the prevalence of obesity in 2016 was estimated at 21.6% [3].…”

Section: Introductionmentioning

confidence: 99%

“…In Spain, the prevalence of obesity in 2016 was estimated at 21.6% [3]. As obesity is associated with serious medical conditions, including endocrine disorders, the growing prevalence of obesity can be expected to translate into an increasing number of obese patients requiring adrenalectomy [2].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study

et al. 2021

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Introduction: Obesity is usually considered a risk factor for surgical complications. Laparoscopic adrenalectomy has replaced open adrenalectomy as the standard operation for adrenal tumors. Objective: To compare the safety of laparoscopic adrenalectomy to treat adrenal tumors in obese versus nonobese patients. Methods: This observational cohort study analyzed consecutive patients who underwent laparoscopic adrenalectomy with a lateral transperitoneal approach at a single center (2003–2020). Data and outcomes of obese (body mass index ≥30 kg/m2) and nonobese patients were compared. To analyze the association between operative time and other variables, we used simple and multivariate linear regression. Results: N = 160 (90 obese/70 nonobese) patients underwent laparoscopic adrenalectomy. Cushing syndrome and pheochromocytoma were the most frequent indications. Obese patients were older (58 vs. 52 years, p < 0.001). A greater proportion of obese patients were ASA grade III + IV (71.1 vs. 48.6%, p = 0.004). Obesity was associated with a longer operative time (72.5 vs. 60 min, p < 0.001) and greater blood loss (40 vs. 20 mL, p = 0.022). There were no differences in conversion, morbidity, or hospital stay. After adjustment for confounding factors, operative time was positively correlated with BMI ≥30 kg/m2, learning curve, estimated blood loss, 2D laparoscopy, and specimen size. Conclusion: Lateral transperitoneal laparoscopic adrenalectomy is safe in patients with a BMI 30–35 kg/m2, so these patients also benefit from this minimally invasive surgery.

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“…15 MetS has previously been shown to negatively impact outcomes in numerous other surgical undertakings, but its association with thyroidectomy remains unknown. [16][17][18][19][20] Although complex, MetS is a lifestyle-dependent illness that has shown to be reversible even on a short-term time scale with vigorous exercise and dieting. [21][22][23] Because the thyroid and MetS share a metabolic relation, thyroidectomies are elective, and MetS is at times a factor under patient control, we believed determining the impact MetS may have on thyroidectomy outcomes to be crucial.…”

Section: Introductionmentioning

confidence: 99%

“…A third of all adults in the United States are believed to have metabolic syndrome and this rate continues to rise 15 . MetS has previously been shown to negatively impact outcomes in numerous other surgical undertakings, but its association with thyroidectomy remains unknown 16‐20 . Although complex, MetS is a lifestyle‐dependent illness that has shown to be reversible even on a short‐term time scale with vigorous exercise and dieting 21‐23 …”

Section: Introductionmentioning

confidence: 99%

Evaluating the impact of metabolic syndrome on postoperative thyroidectomy outcomes

et al. 2020

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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.

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Metabolic syndrome is associated with increased postoperative complications and use of hospital resources in patients undergoing laparoscopic adrenalectomy

Cited by 24 publications

References 23 publications

A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

A Contemporary High-Volume Center Analysis of Postoperative Complications Following Surgical Management of Renal Cell Carcinoma with Tumor Thrombus

Comparison of Outcomes between Obese and Nonobese Patients in Laparoscopic Adrenalectomy: A Cohort Study

Evaluating the impact of metabolic syndrome on postoperative thyroidectomy outcomes

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