The Impact of Metabolic Syndrome on 30-Day Outcomes Following ORIF for Ankle Fractures

Xie, Jack; Malik, Azeem Tariq; Quatman, Carmen E.; Ly, Thuan V.; Phieffer, Laura S.; Khan, Safdar N.

doi:10.1177/1938640019826692

Cited by 7 publications

(6 citation statements)

References 24 publications

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“…Patients with MetS had a 9.1% readmission rate after discharge compared to a 3.7% readmission rate in non-MetS patients (OR 2.62). Our data reaffirm findings from recent literature that show MetS to be a risk factor for increasing 30-day readmission rate after ankle fracture [ 8 ]. These findings further establish that patients with MetS require careful perioperative management to reduce readmission.…”

Section: Discussionsupporting

confidence: 92%

“…The Xie et al. study, which analyzed the impact of MetS on post-operative outcomes after ankle fracture, observed differences that approached statistical significance (p = .054), but ultimately fell short [ 8 ]. Conversely, Cheng et al.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown patients with MetS experience increased morbidity and mortality when compared to other patients suffering from various medical conditions and undergoing common surgical procedures, such as thyroidectomy or emergency appendectomy [3][4][5][6]. Furthermore, there is an emerging branch of literature linking MetS to worsened surgical outcomes within orthopaedics and several studies demonstrate patients with MetS to have increased readmissions and complications in the 30-day period following open reduction and internal fixation (ORIF) for ankle fracture as well as increased rates of wound complication after hip arthroplasty [7,8]. Components of MetS, such as type 2 diabetes, are known to increase fracture and infection risk and to adversely affect orthopaedic surgical outcomes through various pathways [6,[9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Panton¹,

Ranson²,

DeBaun³

et al. 2023

Cureus

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Background Studies demonstrate that metabolic syndrome (MetS) negatively impacts surgical outcomes. This study sought to identify how metabolic syndrome affects outcomes after open reduction and internal fixation (ORIF) of traumatic pilon fractures. Methods Patients who underwent ORIF for pilon fractures from 2012 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with MetS were compared to non-MetS patients for rates of adverse events, prolonged stay, readmission, discharge location, and operative time in the 30-day postoperative period. All statistical analyses were conducted using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Paired student t-tests were used to assess continuous variables. Pearson’s Chi-square and odds ratios were used for categorical variables. Results A total of 1,915 patients met this study’s inclusion criteria, and 127 MetS patients were identified in the cohort. The MetS cohort was older (62.7 vs 49.5 years old, p-value <0.01), with a greater proportion of female patients (59.1% vs 50.2%, p=0.054). MetS patients experienced significantly higher rates of infectious complications (7.9% vs 3.9% OR 2.75 (CI 1.36-5.53), p=0.008), major adverse events (11% vs 4.3%, OR 2.79 (CI 1.53-5.09) p=0.002), and readmissions. MetS patients also had longer lengths of stay (7 days vs 3.8 days, p-value<0.001), and were more likely to be discharged to a non-home location (51.2% vs 19.5%, p-value<0.01, OR 4.32 (CI=3.0-6.24) p<0.001). Conclusion Patients with MetS have an increased risk of 30-day major complications, infection, readmissions, discharge to a non-home location, and prolonged operative time, and therefore warrant additional consideration for perioperative monitoring.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Panton¹,

Ranson²,

DeBaun³

et al. 2023

Cureus

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“…Included Studies). Most studies reported North America data ( n =40) 4 – 6 , 15 , 23 , 27 , 30 – 35 , 38 – 40 , 43 , 46 – 49 , 52 , 53 , 55 – 62 , 65 – 67 , 70 , 73 , 75 – 78 , 80 , with the remaining spanning Europe 19 , 21 , 22 , 24 , 28 , 42 , 44 , 50 , 51 , 64 , 68 , 81 , the Middle East 20 , Asia 37 , 41 , 45 , 71 , 72 , 74 , 82 , 83 , Africa 63 , and South America 54 . The assessed risk of bias of the included studies ranged from 5 to 8 (fair to good) out of a possible 9 stars when assessed using the NOS.…”

Section: Resultsmentioning

confidence: 99%

Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals

Norris,

Gow,

Arthur

et al. 2023

International Journal of Surgery

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Background: Metabolic syndrome is characterised by the presence of at least three of the five following components: insulin resistance, obesity, chronic hypertension, elevated serum triglycerides and decreased high-density lipoprotein cholesterol concentrations. It is estimated to affect 1 in 3 people around the globe and reported to affect 46% of surgical patients. For people with metabolic syndrome who undergo surgery, an emerging body of literature points to significantly poorer postoperative outcomes compared with non-affected populations. The aim of this study is to review the current evidence on risks of surgical complications in patients with metabolic syndrome compared to those without metabolic syndrome. Methods: Systematic review and meta-analysis using PRISMA and AMSTAR reporting guidelines. Results: The meta-analysis included 63 studies involving 1,919,347 patients with metabolic syndrome and 11,248,114 patients without metabolic syndrome. Compared to individuals without the condition, individuals with metabolic syndrome were at an increased risk of mortality (OR 1.75 95% CIs [1.36-2.24]; P <0.01); all surgical site infection types as well as dehiscence (OR 1.64 95% CIs [1.52 -1.77]; P <0.01); cardiovascular complications (OR 1.56 95% CIs [1.41 -1.73]; P <0.01) including myocardial infarction, stroke, cardiac arrest, cardiac arrythmias and deep vein thrombosis; increased length of hospital stay (MD 0.65 95% CIs [0.39-0.9]; P <0.01); and hospital readmission (OR 1.55 95% CIs [1.41-1.71]; P <0.01). Conclusion: Metabolic syndrome is associated with a significantly increased risk of surgical complications including mortality, surgical site infection, cardiovascular complications, increased length of stay and hospital readmission. Despite these risks and the high prevalence of metabolic syndrome in surgical populations there is a lack of evidence on interventions for reducing surgical complications in patients with metabolic syndrome. The authors suggest prioritising interventions across the surgical continuum that include (1) preoperative screening for metabolic syndrome; (2) surgical prehabilitation; (3) intraoperative monitoring and management; and (4) postoperative rehabilitation and follow-up.

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“…This database is a risk-adjusted, outcome-based quality improvement program whose goal is for the improvement of surgical outcomes. All data are validated by trained reviewers through the use of medical records, patient interviews, and operative reports, with a very low disagreement rate [ 12 ]. Variables collected include preoperative, intraoperative, and postoperative data [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

Sadur¹,

Quan²,

Nguyen³

et al. 2023

Cureus

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Purpose Metabolic syndrome is associated with postoperative morbidity and mortality in surgical patients. With the increased use of arthroscopic techniques for rotator cuff repair (RCR), it is important to identify the impact this disorder has on surgical patients. The purpose of this study is to evaluate the clinical impact of metabolic syndrome on outcomes following arthroscopic RCR. Methods The 2006-2019 National Surgical Quality Improvement Program database was queried for adult patients who underwent arthroscopic RCR. Two patient groups were categorized: patients with metabolic syndrome and patients without metabolic syndrome. Demographics, comorbidities, and 30-day postoperative outcomes were compared using bivariate and multivariate analyses. Results Of 40,156 patients undergoing arthroscopic RCR, 36,391 did not have metabolic syndrome and 3,765 had metabolic syndrome. After adjusting for differences in baseline characteristics between the two groups, those with metabolic syndrome had an increased risk of developing renal complications and cardiac complications, as well as requiring hospital admission postoperatively and hospital readmission. Conclusion Metabolic syndrome is an independent risk factor for developing renal and cardiac complications, as well as requiring overnight hospital admission and hospital readmission. Providers should understand the need for preoperative evaluation and surveillance of these patients following their surgery to minimize the risk of poor outcomes.

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The Impact of Metabolic Syndrome on 30-Day Outcomes Following ORIF for Ankle Fractures

Cited by 7 publications

References 24 publications

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Metabolic syndrome and surgical complications: a systematic review and meta-analysis of 13 million individuals

Metabolic Syndrome: Is Arthroscopic Rotator Cuff Repair Safe in This Patient Population?

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