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Impact of Metabolic Syndrome on Postoperative Outcomes Among Medicare Beneficiaries Undergoing Hepatectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

The impact of metabolic syndrome (MetS) on postoperative outcomes following liver surgery is not well studied. The objective of the current study was to examine the association of MetS with individual perioperative outcomes, as well as the composite “textbook outcome” (TO) following liver resection for both benign and malignant indications.

Methods

The Medicare 100% Standard Analytic Files were reviewed to identify Medicare beneficiaries who underwent hepatectomy between 2013 and 2017. The impact of MetS on complications, length of stay (LOS), 90-day readmission, 90-day mortality, and TO following hepatectomy was investigated.

Results

Among 13,898 patients who underwent hepatectomy, 2491 (17.9%) had MetS while 11,407 (82.1%) did not. Patients with MetS were more often male (59.1% vs 48.5%), Black (8.5% vs 6.6%), and had a diagnosis of cancer (69.9% vs 65.1%) (all p<0.001). On multivariable analysis, patients with MetS had higher odds of complications (OR 1.41, 95% CI 1.28–1.55), 90-day readmission (OR 1.27, 95% CI 1.15–1.40), and 90-day mortality (OR 1.32, 95% CI 1.13–1.54). In turn, patients with MetS had markedly lower odds of TO following hepatectomy compared with non-MetS patients (OR=0.76, 95% CI 0.70–0.83). Of note, patients with MetS had lower odds of TO after both minimally invasive (OR=0.59, 95% CI 0.43–0.81) and open (OR=0.75, 95% CI 0.68–0.82) liver surgery. Individuals with MetS also had a higher overall expenditure during the index hospitalization compared with non-MetS patients ($19.9k USD vs. $18.8k USD, p<0.001).

Conclusion

Patients with MetS had increased morbidity and mortality, as well as lower likelihood to achieve a TO following liver resection. MetS increased the operative risk and overall Medicare expenditures associated with hepatic resection.

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Author notes

  1. Alessandro Paro and Diamantis I. Tsilimigras contributed equally as first authors.

Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute, 395 W. 12th Ave., Suite 670, Columbus, OH, USA

    Alessandro Paro, Diamantis I. Tsilimigras, Djhenne Dalmacy, Rayyan S. Mirdad, J. Madison Hyer & Timothy M. Pawlik

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  1. Alessandro Paro
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Correspondence to Timothy M. Pawlik.

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Paro, A., Tsilimigras, D.I., Dalmacy, D. et al. Impact of Metabolic Syndrome on Postoperative Outcomes Among Medicare Beneficiaries Undergoing Hepatectomy. J Gastrointest Surg 25, 2545–2552 (2021). https://doi.org/10.1007/s11605-021-04926-1

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