LAUSR

OBJECTIVES To test the association between metabolic syndrome (MetS) and its components (high blood pressure, BMI ≥ 30, altered fasting glucose, low HDL cholesterol and high triglycerides) on perioperative outcomes after partial nephrectomy (PN). METHODS Within the NIS database (2000-2015) we identified all PN patients. First, temporal trends of MetS were reported. Second, the effect of MetS components was tested in multivariable logistic regression models predicting overall and specific perioperative complications. Third, we tested for dose-response from the concomitant effect of multiple MetS components. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. RESULTS Of 25,875 patients:1)59.3% had high blood pressure, 2)14.7% had BMI ≥ 30, 3)21.7% had altered fasting glucose, 4)20.2% had high triglycerides and 5)<0.01% had low HDL cholesterol. One vs. two vs. three vs. four MetS components were recorded in 34.9% vs. 22.9% vs. 8.9% vs. 2.2% patients. Of all, 11.1% exhibited  ≥ 3 components and qualified for MetS. The rates of MetS increased over time (EAPC:+12.0%;p<0.001). The four tested MetS components (high blood pressure, BMI ≥ 30, altered fasting glucose and high triglycerides) achieved independent predictor status in multivariable models predicting overall, cardiac, miscellaneous medical, vascular and respiratory complications, as well as transfusions. Moreover, a statistically significant dose-response was confirmed for the same endpoints. CONCLUSION MetS and its components consistently and strongly predict perioperative complications after PN. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of  ≥ 3 components has not been met.