背景:代谢综合征(MetS)的特征是心脏代谢异常,例如高血压,肥胖,糖尿病,或血脂异常。本研究旨在评估MetS与腹侧手术后结局的关系,脐带缆,脐带缆和腹壁疝修补术采用成分分离。
方法:美国外科医师学会国家外科质量改善计划数据库用于识别接受腹侧手术的患者,脐带缆,脐带缆2015年至2021年期间进行部件分离的腹壁疝修补术。MetS状态定义为接受糖尿病和高血压药物治疗的患者,体重指数大于30kg/m2。进行倾向匹配以生成具有和不具有MetS的两个平衡队列。T检验和Fisher精确检验评估了群体差异。Logistic回归模型评估了组间的并发症。
结果:在倾向得分匹配后,3930例患者被纳入分析,每组均在1965年(MetS与非MetS)。两组之间疝的严重程度和临床表现存在显着差异。MetS队列的嵌顿疝发生率较高(39.1%对33.2%;P<0.001),与非MetS队列相比,复发性腹侧疝(42.7%对36.5%;P<0.001)。MetS组肾功能不全发生率显著升高(P=0.026),非计划插管(P=0.003),心脏骤停(P=0.005),再手术率(P=0.002)高于非MetS队列。Logistic回归模型显示MetS组术后并发症的可能性更高,包括轻度全身并发症(OR1.25;95CI1.030-1.518;P=0.024),严重的全身并发症(OR1.63;95CI1.248-2.120;P<0.001),和再次手术(OR1.47;95CI1.158-1.866;P=0.002)。两组之间30d伤口并发症的发生率没有显着差异。
结论:代谢紊乱的存在似乎与不良的术后医疗结果和部件分离疝修补术后的再手术率增加有关。这些发现强调了优化术前合并症的重要性,因为外科医生为MetS患者提供咨询。
BACKGROUND: Metabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, or dyslipidemia. This study aims to evaluate the association of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using component separation.
METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify patients who underwent ventral, umbilical, and epigastric hernia repair with component separation between 2015 and 2021. MetS status was defined as patients receiving medical treatment for diabetes mellitus and hypertension, with a body mass index greater than 30 kg/m2. Propensity matching was performed to generate two balanced cohorts with and without MetS. T-tests and Fisher\'s Exact tests assessed group differences. Logistic regression models evaluated complications between the groups.
RESULTS: After propensity score matching, 3930 patients were included in the analysis, with 1965 in each group (MetS versus non-MetS). Significant differences were observed in the severity and clinical presentation of hernias between the groups. The MetS cohort had higher rates of incarcerated hernia (39.1% versus 33.2%; P < 0.001), and recurrent ventral hernia (42.7% versus 36.5%; P < 0.001) compared to the non-MetS cohort. The MetS group demonstrated significantly increased rates of renal insufficiency (P = 0.026), unplanned intubation (P = 0.003), cardiac arrest (P = 0.005), and reoperation rates (P = 0.002) than the non-MetS cohort. Logistic regression models demonstrated higher likelihood of postoperative complications in the MetS group, including mild systemic complications (OR 1.25; 95%CI 1.030-1.518; P = 0.024), severe systemic complications (OR 1.63; 95%CI 1.248-2.120; P < 0.001), and reoperation (OR 1.47; 95%CI 1.158-1.866; P = 0.002). There were no significant differences in the rates of 30-d wound complications between groups.
CONCLUSIONS: The presence of metabolic derangement appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the importance of optimizing preoperative comorbidities as surgeons counsel patients with MetS.