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October 16, 2007
8:00 AM - 11:00 AM
Room Gateway Ballroom 102
Prevalence and Implications of Metabolic Syndrome in the Total Joint Arthroplasty Patient
Kishor Gandhi, M.D., M.P.H., Eugene Viscusi, M.D., Eric Schwenk, B.A., Luis Pulido, M.D., Javad Parvizi, M.D.
Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Introduction: Diabetes, hypertension, obesity, and dyslipidemia have been categorized under a complex but controversial entity called the metabolic syndrome. The World Health Organization (WHO) and the National Cholesterol Education Program/ ATP III have developed guidelines to define the syndrome. The objective of this analysis was to determine if there is a difference in the occurrence of postoperative cardiovascular complications after total joint arthroplasty between patients with and without metabolic syndrome.

Methods: Following IRB approval of this retrospective study, the sample for this analysis (n=1231) consisted of all patients who underwent primary hip and knee surgeries between January and August 2006. Patient information was gathered in a database with local and systemic complications. The past medical history of these patients was extracted from the preoperative clearance office and medical records at a tertiary care academic university hospital. A modified definition of the metabolic syndrome was developed based on ATP III guidelines. Metabolic syndrome was defined by the presence of three of the four following criteria: Obesity (BMI≥30), Diabetes, Hypertension, or Dyslipidemia. Bivariate and multivariate analyses were conducted to compare patients with and without metabolic syndrome. Primary outcomes measured were the occurrence of any postoperative cardiovascular complications (myocardial infarctions, arrhythmias, CHF, DVT, and PE's) after adjusting for potential confounders (age, gender, race, smoking status, presence of metabolic syndrome).

Results: Using a modified ATP III guidelines, 24.4 % (n=300) of the population undergoing hip and knee arthroscopy had metabolic syndrome. The average age of patients with metabolic syndrome was 64.4, while mean age of patients without metabolic syndrome was 62.2 years (Table 1). There were no significant differences between those with and without metabolic syndrome in terms of sex and smoking status.

Analysis of our data showed 347 patients following hip and knee arthroscopy to have one or more postoperative complications (Table 2). Patients with metabolic syndrome had higher percentage of total complications (O.R. 1.05), as well as cardiovascular complications (O.R. 1.30). However, a logistic regression model adjusting for age, sex, race, and smoking status showed the difference to be non-significant.

Conclusion: This is an ongoing study in which preliminary analysis shows patients who meet the criteria for metabolic syndrome have a trend toward increased risk of developing postoperative cardiovascular complications. Although the differences between the two did not reach statistical significance, inclusion of a larger sample size may avoid the type II error and show difference. Our initial conclusion is that metabolic syndrome may serve as a screening tool to allow better utilization of limited healthcare resources and enable implementation of strategies that optimize these patients and can minimize these untoward complications.[figure1]

Anesthesiology 2007; 107: A1425
Figure 1