Charleston Orthopaedic Associates, 1012 Physicians Drive, Charleston, SC, 29414, USA,
Clin Orthop Relat Res. 2013 Oct;471(10):3358-66. doi: 10.1007/s11999-013-3049-9. Epub 2013 May 14.
Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking.
QUESTIONS/PURPOSES: The purposes of this study were to determine whether morbid obesity increased the risk of: (1) venous thromboembolism (VTE), (2) bleeding, (3) other adverse events, and (4) infections during the early postoperative period (up to 6 to 8 weeks) after THA or TKA?
Data from the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) clinical trial program of rivaroxaban for prevention of VTE after THA or TKA were analyzed retrospectively. Data for 12,355 patients were reviewed to identify complication rates in morbidly obese patients (BMI≥40 kg/m2) compared with patients with a BMI less than 40 kg/m2. Explorative analyses compared the rates of asymptomatic deep vein thrombosis (DVT), symptomatic DVT, symptomatic pulmonary embolism, bleeding, and other adverse events by BMI group.
There were no significant differences in asymptomatic DVT, symptomatic DVT, symptomatic pulmonary embolism, or bleeding, but there were increases in other adverse events (including receipt of blood transfusion, erythema, peripheral edema, diarrhea, gastrointestinal or abdominal pain) and infections (including respiratory tract or lung infections, wound inflammation or infection, and extrasurgical-site infections), in patients with a BMI of 40 kg/m2 or greater compared with patients with a BMI less than 40 kg/m2.
After THA or TKA, morbid obesity is not associated with an increased risk of VTE or bleeding but is associated with increased early postoperative complications, including erythema, peripheral edema, diarrhea and gastrointestinal or abdominal pain, wound inflammation or infection, extrasurgical-site infections, and respiratory tract or lung infections.
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
病态肥胖已被证实是 THA 和 TKA 后并发症增加的一个危险因素；然而，缺乏能够确定其影响大小的大型研究。
问题/目的：本研究的目的是确定病态肥胖是否增加了：（1）静脉血栓栓塞（VTE）、（2）出血、（3）其他不良事件以及（4）THA 或 TKA 后早期（6 至 8 周内）感染的风险？
回顾性分析了 RECORD 临床试验中利伐沙班预防 THA 或 TKA 后 VTE 的 rivaroxaban 数据，该试验旨在调节骨科手术中的凝血以预防深静脉血栓形成和肺栓塞。对 12355 例患者的数据进行了审查，以确定病态肥胖患者（BMI≥40kg/m2）与 BMI ＜40kg/m2 患者的并发症发生率。通过 BMI 组比较了无症状深静脉血栓形成（DVT）、症状性 DVT、症状性肺栓塞、出血和其他不良事件的发生率。
无症状 DVT、症状性 DVT、症状性肺栓塞或出血无显著差异，但 BMI 为 40kg/m2 或以上的患者发生其他不良事件（包括输血、红斑、外周水肿、腹泻、胃肠道或腹痛）和感染（包括呼吸道或肺部感染、伤口炎症或感染以及手术部位以外的感染）的风险增加。
THA 或 TKA 后，病态肥胖与 VTE 或出血风险增加无关，但与早期术后并发症增加相关，包括红斑、外周水肿、腹泻和胃肠道或腹痛、伤口炎症或感染、手术部位以外的感染以及呼吸道或肺部感染。
III 级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
