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The Impact of Metabolic Syndrome on 30-Day Outcomes Following Elective Anterior Cervical Discectomy and Fusions

Malik, Azeem Tariq, MBBS; Jain, Nikhil, MD; Kim, Jeffery, MD; Yu, Elizabeth, MD; Khan, Safdar N., MD

doi: 10.1097/BRS.0000000000002824

Study Design. Retrospective review of prospective registry

Objective. To analyze the impact of metabolic syndrome (MetS) on 30-day outcomes following elective anterior cervical discectomy and fusions (ACDFs).

Summary of Background Data. MetS is defined as the presence of a combination of hypertension, diabetes mellitus, and obesity. Past literature has reported MetS to complicate postoperative care in patients undergoing various surgical procedures, including lumbar fusions.

Methods. The 2015 to 2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using current procedural terminology (CPT) codes 22,551 (single-level) and 22,552 (additional level). Patients undergoing disc arthroplasty, multi-level (>3) fusion, posterior cervical spine surgery, and patients with fracture, tumor, infection were excluded. MetS was defined using a pre-set criteria used by other NSQIP studies as the presence of—(1) diabetes mellitus, (2) hypertension requiring medication, and (3) body mass index (BMI) more than or equal to 30 kg/m2.

Results. A total of 1384 (8.8%) patients with MetS underwent a cervical fusion. Following adjusted analysis, results showed that presence of MetS was associated with higher odds of a prolonged length of stay more than or equal to 3 days (odds ratios [OR] 1.32 [95% confidence interval [CI] 1.12–1.56]; P = 0.001). No significant association was found between MetS and 30-day complications, 30-day reoperations, 30-day re-admissions, a non-home discharge, and death.

Conclusion. While MetS was associated with a prolonged length of stay, its presence does not have a large impact on 30-day outcomes following elective ACDF.

Level of Evidence: 3

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus Ohio.

Address correspondence and reprint requests to Safdar N. Khan, MD, Division of Spine Surgery, Department of Orthopaedic Surgery, Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute (, Wexner Medical Center at The Ohio State University, Columbus, OH; E-mail:

Received 23 April, 2018

Revised 9 July, 2018

Accepted 17 July, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.