LAUSR

BACKGROUND Metabolic syndrome (MetS) is a disorder characterized by a constellation of cardiometabolic risk factors including abdominal obesity, dyslipidemia, hypertension, and glucose intolerance that has been associated with adverse perioperative outcomes. We evaluated outcomes for MetS patients after carotid endarterectomy (CEA) in the largest population to date. METHODS We performed a matched cohort analysis using clinical data from 2012-2018 in the ACS National Surgical Quality Improvement Program (NSQIP). We used propensity scores to match patients to attain covariate balance and used logistic regression to assess odds of unfavorable outcomes, including a predefined primary outcome of composite cardiovascular incident. RESULTS We identified 50,423 eligible adult patients, of whom 14.2% qualified for MetS (n = 7,156). MetS patients tended to have CEA at an earlier age, more functional dependence, and longer operative durations. After matching, MetS remained associated with the primary outcome of combined cardiovascular incident (OR = 1.42, 95% CI = 1.18 - 1.72, p < 0.001), stroke (OR = 1.44, 95% CI = 1.12 - 1.85, p = 0.004), prolonged length of stay (OR = 1.31, 95% CI = 1.18 - 1.44, p < 0.001), and discharge-to-facility (OR = 1.32, 95% CI = 1.08 - 1.61, p = 0.007). We also found that obesity alone is protective against combined cardiovascular incident, while hypertension with diabetes and MetS increase odds of a cardiovascular complication. CONCLUSION Metabolic syndrome is associated with adverse outcomes for adult patients undergoing elective CEA.