Metabolic syndrome and the risk of perioperative ischemic stroke in non-cardiac surgery: a case-control retrospective study

Background Perioperative ischemic stroke (PIS), although rare, is a devastating complication following surgery. Metabolic syndrome (MetS), also known as insulin resistance syndrome, is characterized by obesity, diabetes, hypertension and dyslipidemia. MetS has been reported to be associated with surgical complications. However, the association between PIS and MetS remains unclear. Methods We conducted a case-control study by selecting 139,191 participants from 223,415 non-cardiac surgery patients at the Chinese PLA General Hospital between 2008 and 2019. Univariate and multivariate logistic regression analyses were performed to examine the association of MetS and PIS. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were applied to address the potential confounding effects of covariates. Subgroup and sensitivity analyses were performed to verify the robustness of the association between MetS and PIS. Results Among 139,191 participants, 328 (0.24%) developed PIS. Participants with MetS had a 2.18-fold increased risk of PIS. In the PSM and IPTW models, the odds ratios for MetS were 1.41 and 1.35, respectively. Subgroup analyses showed that the association remained significant. In sensitivity analyses, the results remained robust after excluding patients on specific medications and those with a prognostic nutrition index (PNI) less than 38.8. Conclusions This study confirms MetS as an independent predictor of PIS among non-cardiac surgical patients in China, with elevated blood pressure and glucose as the principal drivers of this association. Abnormal parameters in MetS, especially elevated glucose levels and elevated blood pressure, are significantly associated with increased odds of PIS. Surgical patients with MetS require increased attention to PIS prevention.