Cardiovascular, Pulmonary, and Renal Risk Factors in Patients with Metabolic Syndrome Undergoing Anterior Skull Base Surgery

Objective: The purpose of this study is to investigate cardiovascular, pulmonary, and renal risk factors in patients with metabolic syndrome undergoing anterior skull base surgery. We sought to determine whether there is an independent effect of metabolic syndrome on postoperative cardiovascular, pulmonary, and renal complications.

Study Design: This is a retrospective database review.

Methods: The 2005 to 2015 National Surgical Quality Improvement Program (NSQIP) database was used to identify patients with metabolic syndrome who underwent anterior skull base surgery. Chi-squared analysis and logistic regression were used to determine statistical association between covariates and postoperative events.

Results: A total of 4,053 patients who underwent anterior skull base surgery were identified using the NSQIP database. 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 fit this inclusion criteria. Univariate analysis revealed a significant association between patients with metabolic syndrome and history of cardiac surgery (p = 0.001) and history of percutaneous cardiac intervention (p = 0.001). Univariate analysis demonstrated that patients with metabolic syndrome were at higher risk for postoperative myocardial infarction (p = 0.005). After accounting for the comorbid cardiovascular risk factors in a logistic regression model, metabolic syndrome remained significantly associated with postoperative myocardial infarction in this patient cohort. Furthermore, univariate analysis demonstrated a statistical significance between our patient cohort and comorbid chronic obstructive pulmonary disease (COPD; p = 0.034) and comorbid dyspnea (p = 0.01). However, logistic regression demonstrated that hypertension medication usage was the greatest predictor of comorbid COPD (p = 0.00; OR = 2.03, 95% CI: 1.2–3.89) and dyspnea (p = 0.01; OR = 2.18, 95% CI: 1.42–2.86). Logistic regression found that our patient cohort did not have significantly increased risk for postoperative ventilator use (p = 0.788) when compared with patients with obesity, hypertension, or diabetes alone. Univariate analysis demonstrated a statistically significant association between patients with metabolic syndrome and postoperative renal insufficiency (p = 0.001); however, this did not hold true in logistic regression modelling. Patients with diabetes alone also were associated with postoperative renal insufficiency (p = 0.049).

Conclusion: Our study found that patients with metabolic syndrome who underwent anterior skull base surgery, postoperative myocardial infarction remained a statistically significant event in the 30-day postoperative window despite adjusting for comorbid cardiac risk factors. Patients with metabolic syndrome undergoing anterior skull base surgery demonstrated a significant association with comorbid COPD and comorbid dyspnea. Antihypertensive medication was found to be the greatest predictor of these comorbid pulmonary complications. Patients with metabolic syndrome or diabetes mellitus were significantly more likely to have postoperative renal insufficiency.

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

Publication History

Article published online:
12 February 2021