Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement: A Propensity-matched Analysis

Eric Zhao; Daniel J Shinn; Mark Basilious; Tejas Subramanian; Pratyush Shahi; Troy B Amen; Omri Maayan; Sidhant Dalal; Kasra Araghi; Junho Song; Evan D Sheha; James E Dowdell; Sravisht Iyer; Sheeraz A Qureshi

doi:10.1097/BSD.0000000000001567

Impact of Metabolic Syndrome on Early Postoperative Outcomes After Cervical Disk Replacement: A Propensity-matched Analysis

Clin Spine Surg. 2024 Feb 5. doi: 10.1097/BSD.0000000000001567. Online ahead of print.

Authors

Eric Zhao^{1

2}, Daniel J Shinn^{1

2}, Mark Basilious², Tejas Subramanian^{1

2}, Pratyush Shahi¹, Troy B Amen¹, Omri Maayan^{1

2}, Sidhant Dalal¹, Kasra Araghi¹, Junho Song¹, Evan D Sheha¹, James E Dowdell¹, Sravisht Iyer¹, Sheeraz A Qureshi¹

Affiliations

¹ Hospital for Special Surgery.
² Weill Cornell Medicine, New York, NY.

PMID: 38321612
DOI: 10.1097/BSD.0000000000001567

Abstract

Study design: Retrospective cohort study.

Objective: To compare the demographics, perioperative variables, and complication rates following cervical disk replacement (CDR) among patients with and without metabolic syndrome (MetS).

Summary of background data: The prevalence of MetS-involving concurrent obesity, insulin resistance, hypertension, and hyperlipidemia-has increased in the United States over the last 2 decades. Little is known about the impact of MetS on early postoperative outcomes and complications following CDR.

Methods: The 2005-2020 National Surgical Quality Improvement Program was queried for patients who underwent primary 1- or 2-level CDR. Patients with and without MetS were divided into 2 cohorts. MetS was defined, according to other National Surgical Quality Improvement Program studies, as concurrent diabetes mellitus, hypertension requiring medication, and body mass index ≥30 kg/m2. Rates of 30-day readmission, reoperation, complications, length of hospital stay, and discharge disposition were compared using χ2 and Fisher exact tests. One to 2 propensity-matching was performed, matching for demographics, comorbidities, and number of operative levels.

Results: A total of 5395 patients were included for unmatched analysis. Two hundred thirty-six had MetS, and 5159 did not. The MetS cohort had greater rates of 30-day readmission (2.5% vs. 0.9%; P=0.023), morbidity (2.5% vs. 0.9%; P=0.032), nonhome discharges (3% vs. 0.6%; P=0.002), and longer hospital stays (1.35±4.04 vs. 1±1.48 days; P=0.029). After propensity-matching, 699 patients were included. All differences reported above lost significance (P>0.05) except for 30-day morbidity (superficial wound infections), which remained higher for the MetS cohort (2.5% vs. 0.4%, P=0.02).

Conclusions: We identified MetS as an independent predictor of 30-day morbidity in the form of superficial wound infections following single-level CDR. Although MetS patients experienced greater rates of 30-day readmission, nonhome discharge, and longer lengths of stay, MetS did not independently predict these outcomes after controlling for baseline differences in patient characteristics.

Level of evidence: Level III.