Research ArticleComplications

The Inherent Value of Preoperative Optimization—Absolute and Incremental Reduction in Components of Metabolic Syndrome Can Enhance Recovery and Minimize Perioperative Burden

Sara Naessig, Ashok Para, Kevin Moattari, Bailey Imbo, Tyler K. Williamson, Rachel Joujon-Roche, Peter Tretiakov, Lara Passfall, Oscar Krol, Nicholas Kummer, Waleed Ahmad, Katherine Pierce, Ethan Ayres, Shaleen Vira, Bassel Diebo and Peter G. Passias
International Journal of Spine Surgery June 2022, 16 (3) 412-416; DOI: https://doi.org/10.14444/8255

Article Figures & Data

Tables

  • Table 1

    Basic demographics of study population.

    DemographicMetabolicNonmetabolic P Value
    Age, y, mean ± SD62 ± 1255.9 ± 16.1<0.001
    Charlson Comorbidity Index, mean ± SD0.8 ± 1.40.6 ± 1.2<0.001
    Women, %51.3%53%<0.001
    Procedure invasiveness6 3.93.2<0.001
  • Table 2

    Surgical characteristics of study population.

    CharacteristicsMetabolicNonmetabolic P Value
    Posterior approach39.7%29.0%<0.001
    Anterior approach22.0%21.2%<0.001
    Combined approach5.0%4.3%<0.001
    Decompression68.8%55.0%<0.001
    Fusion67.7%55.5%<0.001
    2- to 3-Level fusions51.8%43.1%<0.001
    4- to 8-Level fusions13.6%9.5%<0.001
    >9-Level fusions0.7%1.4%<0.001
  • Table 3

    Postoperative complications among study population.

    ComplicationMetabolicNonmetabolic P Value
    Bowel9.7%6.8%<0.001
    Bladder1.3%0.9%<0.001
    Neurologic2.3%1.4%<0.001
    Dysphagia0.1%0.1%0.34
    Cardiac0.6%0.4%<0.001
    Respiratory0.6%0.4%<0.001
    Digestive0.3%0.3%0.98
    Device3.5%2.9%<0.001
    Hematoma1.1%0.7%<0.001
    Anemia9.8%5.9%< 0.001
    Infection0.9%0.5%<0.001
    Deep vein thrombosis0.6%0.4%<0.001
    Total28.8%19.7%<0.001
    Revision surgery4.5%5.9%<0.001
  • Table 4

    Postoperative complications by metabolic factor.

    Complication2 Factors3 Factors4 Factors P Value
    Bowel9.5%10.9%12.2%<0.001
    Bladder1.3%1.4%1.7%<0.001
    Neurologic2.3%2.3%2.5%0.82
    Dysphagia0.1%0.1%0.0%0.06
    Cardiac0.6%0.6%0.6%0.37
    Respiratory0.5%0.6%0.7%<0.001
    Digestive0.3%0.3%0.0%0.07
    Device3.5%3.7%1.7%<0.001
    Hematoma1.0%1.2%1.0%<0.001
    Anemia9.5%11.3%10.9%<0.001
    Infection0.8%1.0%0.3%<0.001
    Deep vein thrombosis0.5%0.7%1.0%<0.001
    Mortality0.3%0.2%0.7%<0.001
    Length of Stay4.25 ± 4.94.47 ± 4.84.27 ± 5.2<0.001
    Total complications28.2%31.3%30.3%<0.001
    Revision surgery5.9%6.4%5.1%<0.001
  • Table 5

    Complications by specific factors of metabolic syndrome.

    FactorComplication TotalRevision
    OR P ValueOR P Value
    Hypertension, diabetes, and trigylcerides0.67 (0.62–0.73)<0.0010.9 (0.7–1.1)0.36
    Hypertension, obesity, and diabetes1.5 (1.4–1.5)<0.0010.82 (0.8–0.84)<0.001
    Hypertension, obesity, and trigylcerides0.66 (0.58–0.75)<0.0010.62 (0.5–0.7)<0.001
    Obesity and trigylcerides0.52 (0.44–0.62)<0.0011.04 (0.7–1.5)0.82
    Hypertension and triglycerides0.65 (0.1–0.69)<0.0010.82 (0.73–0.92)<0.05
    Diabetes and triglycerides0.63 (0.51)<0.0011.8 (0.9–3.4)0.054
    Hypertension and diabetes0.7 (0.74–0.75)<0.0010.88 (1.24–1.25)<0.001
    Hypertension and obesity0.7 (0.7–0.71)<0.0010.82 (0.8–0.84)<0.001
    Obesity and diabetes0.7 (0.6–0.7)<0.0010.77 (0.7–0.8)<0.001
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The Inherent Value of Preoperative Optimization—Absolute and Incremental Reduction in Components of Metabolic Syndrome Can Enhance Recovery and Minimize Perioperative Burden
Sara Naessig, Ashok Para, Kevin Moattari, Bailey Imbo, Tyler K. Williamson, Rachel Joujon-Roche, Peter Tretiakov, Lara Passfall, Oscar Krol, Nicholas Kummer, Waleed Ahmad, Katherine Pierce, Ethan Ayres, Shaleen Vira, Bassel Diebo, Peter G. Passias
International Journal of Spine Surgery Jun 2022, 16 (3) 412-416; DOI: 10.14444/8255
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