Metabolic syndrome as a predictor of perioperative outcomes in primary bariatric surgery, a MBSAQIP survey

Background Among bariatric surgery patients, body mass index (BMI) does not fully capture the severity of obesity and it may be complicated to stratify patients at higher risk of peri-operative complications. In our study, we surveyed the MBSAQIP database to determine whether bariatric patients with metabolic syndrome (MetS) are at higher risk for peri-operative complications. Methods MBSAQIP database was used to investigate the correlation between MetS and perioperative outcomes. All patients between 2015 and 2018, >= 18 years old, who underwent primary bariatric surgery were included. Patients were excluded if they underwent natural orifice transluminal endoscopic surgery or had surgery performed by gastroenterologist or interventional radiologist. We modified the International Diabetes Federation definition of MetS for our study to select patients with BMI > 30 in addition to two or more of the following comorbidities: hypertension, hyperlipidemia, or diabetes. The primary outcome was perioperative mortality. Secondary outcomes included post-operative surgical site infections (SSI), perioperative MI, stroke, acute renal failure, transfusion requirement, readmission, conversion to open and reoperation. Results Between 2015 and 2018, 760,076 bariatric operations were performed. 670,935 met criteria for analysis. 190,239 patients were identified to have MetS. Patients with MetS were found to have higher odds of death (OR 2.32; 95% CI 1.97-2.72), SSI (OR 1.39; 95% CI 1.31-1.48), perioperative MI ( OR 4.70; 95% CI 3.42-6.45), stroke (OR 3.30; 95% CI 2.08-5.24), acute renal failure (OR 3.04; 95% CI 2.48-3.72), and transfusion requirement (OR 1.30; 95% CI 1.33-1.39). Conclusion Patients with metabolic syndrome are at increased odds of peri-operative complications after bariatric surgery.