The impact of metabolic syndrome on postoperative outcomes in breast oncoplastic surgery: A nationwide analysis

Introduction Metabolic syndrome (MetS), defined by obesity, hypertension, impaired glucose, high triglycerides, and low HDL cholesterol, affects nearly one-third of adults globally and is increasingly common among patients with breast cancer. Given the rising popularity of oncoplastic breast surgery (OPS), we investigated the relationship between MetS and postoperative outcomes in OPS. Methods A retrospective cohort study using the ACS-NSQIP database (2007–2023) examined patients with breast cancer who underwent Level I, II, and III OPS. Patients were classified as having MetS if they had diabetes treatment, hypertension medication, and BMI >30 kg/m². Postoperative complications were evaluated by comparing patients with and without MetS. Results Of the 9631 patients undergoing OPS between 2007 and 2023, 742 (7.7%) had MetS. Overall postoperative complications were significantly higher among patients with MetS compared to those without (8.8% vs. 4.2%, p<0.001), driven by increased wound (5.7% vs. 2.3%, p<0.001) and medical complications (1.6% vs. 0.4%, p<0.001). Multivariate analysis confirmed that MetS significantly increased the risk of overall (OR 1.78, p<0.001), wound (OR 1.97, p=0.001), and medical complications (OR 2.28, p=0.024). MetS specifically increased the risk of overall and medical complications in Level I procedures, whereas in Level II and III procedures, it was a significant predictor of overall and wound complications. Conclusion MetS significantly increases postoperative wound and medical complications in patients undergoing oncoplastic breast surgery. Preoperative identification and tailored perioperative management of MetS patients are essential to reduce complications and enhance surgical outcomes.