Sepsis and Wound Complications in Patients with Metabolic Syndrome Undergoing Anterior Skull Base Surgery

Objective: The purpose of this study is to investigate if there with regards to timing of perioperative and postoperative wound complications and sepsis in patients with metabolic syndrome undergoing anterior skull base surgery.

Study Design: Retrospective database review.

Methods: The 2005–2015 National Surgical Quality Improvement Program (NSQIP) database was used. Chi-squared analysis and multivariate regression were used to determine statistical association between patient cohorts and postoperative events.

Results: A total of 4,053 patients were identified as undergoing anterior skull base surgery. Patients who met inclusion criteria for metabolic syndrome included those with three comorbid conditions, specifically diabetes mellitus, BMI ≥ 30 kg/m², and hypertension medication usage. A cohort of 286 patients fits this inclusion criterion. Univariate analysis showed that our patient cohort was significantly associated with postoperative systemic sepsis (p = 0.007) and postoperative septic shock (p = 0.008). Our analysis found no difference in timing for postoperative sepsis when comparing patients with metabolic syndrome and those without. However, t-test analysis found that our patient cohort with metabolic syndrome experienced septic shock at an earlier time point in the postoperative period (p = 0.008). Patients with metabolic syndrome experienced septic shock earlier in the postoperative period when compared with patients without metabolic syndrome. Univariate analysis demonstrated significant association between metabolic syndrome and postoperative wound infection (p = 0.041) and wound contamination (p = 0.020). Logistic regression analysis revealed a significantly greater likelihood of wound contamination in patients with metabolic syndrome (OR: 3.024, CI 95%: 1.024–8.928, p = 0.045) when compared with patients with comorbid obesity, diabetes mellitus, or hypertension only.

Conclusion: Patient cohorts that fit inclusion criteria for metabolic syndrome undergoing anterior skull base surgery had a statistically significant association with sepsis and septic shock. There was no difference in timing regarding postoperative sepsis; however, patients with metabolic syndrome developed postoperative septic shock at an earlier time point. Patients with metabolic syndrome demonstrated a significant association with wound contamination and infection.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021