The Metabolic Syndrome Paradox: Increased Morbidity and Decreased Mortality in Operative Orthopedic Trauma

Abstract

We examined the impact of metabolic syndrome (MetS) on operative outcomes with orthopedic trauma, particularly among patients with pelvic, acetabular, and lower extremity fractures. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who had operative pelvic, acetabular, and lower extremity trauma from 2006 through 2014. We defined MetS as type 2 diabetes, a history of hypertension requiring medication, and body mass index of 30 kg/m 2 or greater. Patients with MetS were compared with unaffected patients and assessed for association with in-hospital complications and mortality. The study population included 37,495 patients; 5.7% (n=2154) had MetS. On multivariable logistic regression, MetS was associated with increased odds of any hospital complication (odds ratio [OR], 1.30; 95% CI, 1.13–1.51; P <.001), Clavien-Dindo grade IV complications (OR, 1.51; 95% CI, 1.23–1.87; P <.001), readmission (OR, 1.39; 95% CI, 1.18–1.63; P <.001), and reoperation (OR, 1.40; 95% CI, 1.11–1.76; P =.004). Conversely, MetS significantly decreased the odds of mortality (OR, 0.67; 95% CI, 0.49–0.92; P =.01). Although MetS is a risk factor for postoperative complications, longer length of stay, and increased readmission after surgical intervention for orthopedic lower extremity trauma, MetS appears to decrease the odds of mortality in this specific patient population, which merits further investigation. [ Orthopedics . 2022;45(2):103–108.]