Metabolic Syndrome and the Risk of Postoperative Complications Following Esophagectomy: National Surgical Quality Improvement Program Study

Introduction

Metabolic syndrome has become a major health risk affecting patients worldwide and has been shown to be a risk factor for postoperative complications following abdominal surgery. This study aims to elucidate the link between metabolic syndrome and postoperative complications and mortality following esophagectomy.

Methods

This is a retrospective study analyzing the American College of Surgeons National Surgical Quality Improvement Program database (2017-2021). This study compared 30-d postoperative complications of patients undergoing esophagectomy with and without metabolic syndrome. Metabolic syndrome was defined as obesity (body mass index ≥30 kg/m2), diabetes, and hypertension.

Results

A total of 4911 patients met the study criteria, and of these, 303 patients (6.17%) met the inclusion criteria for the modified definition of metabolic syndrome. The metabolic syndrome group had higher American Society of Anesthesiologists scores compared to the control group (American Society of Anesthesiologists 3 or 4: 96% versus 84%, P < 0.001). Operative time was significantly higher in the metabolic syndrome group (378 mins versus 361, P = 0.004). Mortality was higher in the metabolic syndrome group (4.3% versus 2.3%, P = 0.03), as was serious morbidity (35% versus 30%, P = 0.05). Metabolic syndrome patients also had higher risks of postoperative complications of pneumonia (18.5% versus 14%, P = 0.04), unplanned intubation (15.5% versus 9.9%, P = 0.002), and sepsis (7.6% versus 4.9%, P = 0.04). On multivariate analysis, 30-d mortality was increased in the metabolic syndrome group.

Conclusions

Metabolic syndrome patients who undergo esophagectomy are associated with increased rates in morbidity and mortality. When controlled for other patient factors in multivariate analysis, 30-d mortality also had an associated increase. By focusing on modifiable risk factors with metabolic syndrome patients, mortality and morbidity for this high-risk procedure could be reduced in the future.