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The Impact of Metabolic Syndrome on Post-Operative Outcomes in Hernia Repair with Component Separation: A Propensity Score-Matched Nationwide Analysis
Maria J. Escobar-Domingo, MD1 Angelica Hernandez Alvarez, MD1 Erin Kim, BA1 James E. Fanning, BS1 Samuel J. Lin, MD, MBA1 Bernard T. Lee, MD, MBA, MPH1 1Beth Israel Deaconess Medical Center, Boston, MA

Background: Metabolic syndrome (MetS) is characterized by cardiometabolic abnormalities such as hypertension, obesity, diabetes, and dyslipidemia. Despite its rising prevalence, the safety profiles of patients with MetS undergoing hernia repair with component separation remain unexplored. This study aims to evaluate the impact of MetS on the postoperative outcomes of ventral, umbilical, and epigastric hernia repair using the component separation technique.

Methods: The ACS-NSQIP database was used to identify patients who underwent hernia repair with component separation between 2015 and 2021. Propensity score matching resulted in cohorts based on the presence of MetS, defined as patients diagnosed with diabetes mellitus, hypertension, and obesity. T-tests and Fisher's Exact tests assessed group differences. Logistic regression models evaluated postsurgical complications.

Results: After propensity score matching, 3,930 patients were included in the analysis, with 1,965 in each group. The MetS cohort had higher rates of incarcerated hernia(p<0.001), and recurrent ventral hernia(p<0.001) compared to the non-MetS cohort. The MetS group demonstrated increased rates of unplanned intubation(p=0.003), cardiac arrest(p=0.005), and reoperation rates(p=0.002). Logistic regression models showed a higher likelihood of mild systemic complications(OR1.25; 95%CI 1.030-1.518; p=0.024), severe systemic complications(OR1.63; 95%CI 1.248-2.120; p<0.001), and reoperation(OR 1.47; 95%CI 1.158-1.866; p=0.002) in the MetS group. There were no significant differences in wound complication rates between groups.

Conclusion: MetS appears to be associated with adverse postoperative medical outcomes and increased reoperation rates after hernia repair with component separation. These findings highlight the impact of MetS as a cluster of modifiable risk factors and call for surgeons to consider this condition during patient counseling, surgical planning, and postoperative care.
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