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

Background: Rates of obesity and metabolic syndrome continue to rise worldwide; however, the impact of metabolic syndrome on outcomes following adrenalectomy has not been described. In this study, we sought to investigate the effects of metabolic syndrome on postoperative 30-day morbidity, mortality, and utilization of hospital resources in a large cohort of patients undergoing elective laparoscopic adrenalectomy.

Methods: Patients who underwent laparoscopic adrenalectomy from 2005 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with body mass index ≥30 kg/m² who also had diabetes and hypertension requiring medications were defined as having metabolic syndrome. Univariate and multivariable analyses were performed for the outcomes of 30-day mortality/morbidity, major complications, and utilization of hospital resources (prolonged duration of stay ≥3 days and requirement for perioperative blood transfusion).

Results: Of the 3,502 patients included in the study, 395 had metabolic syndrome (11.3%). Patients with metabolic syndrome were older (P < .001) and had a greater percentage of preoperative comorbidities (P < .05) than patients without metabolic syndrome. On unadjusted analysis, metabolic syndrome was associated with an increased risk for mortality/morbidity, major complications, duration of stay, operative time, and risk for blood transfusion (all P < .001). On multivariable analysis, metabolic syndrome was an independent predictor of overall mortality/morbidity (odds ratio, 1.86; P < .001), major complications (odds ratio, 1.99; P < .001), pulmonary complications (odds ratio, 1.83; P = .049), the need for blood transfusion (odds ratio, 1.94; P = .04), and prolonged length of stay (odds ratio odds ratio, 1.34; P = .02).

Conclusion: The presence of metabolic syndrome increased the risk for postoperative complications after laparoscopic adrenalectomy and was associated with 2-fold risk for blood transfusion and 34% increased odds of a prolonged hospital stay.