Gupta Anil K, Chalmers Peter N, Rahman Zain, Bruce Benjamin, Harris Joshua D, McCormick Frank, Abrams Geoffrey D, Nicholson Gregory P
Section of Shoulder and Elbow Surgery, Midwest Orthopaedics at Rush, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Section of Shoulder and Elbow Surgery, Midwest Orthopaedics at Rush, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
J Shoulder Elbow Surg. 2014 Jan;23(1):35-42. doi: 10.1016/j.jse.2013.07.043. Epub 2013 Sep 30.
Body mass index (BMI) is an independent predictor of complications after hip and knee arthroplasty. Whether similar trends apply to patients undergoing reverse total shoulder arthroplasty (RTSA) is unknown.
A retrospective review of primary RTSAs with a minimum 90-day follow-up were included. Complications were classified as major or minor and medical or surgical. Patients were classified into 3 groups: normal BMI (BMI <25 kg/m(2)), overweight or mildly obese (BMI 25-35 kg/m(2)), and moderately or severely obese (BMI >35 kg/m(2)).
Of the 119 patients met our inclusion criteria, 30 (25%) had a BMI of less than 25 kg/m(2); 65 (55%) had a BMI of 25 to 35 kg/m(2), and 24 (20%) had BMI exceeding 35 kg/m(2). Complications occurred in 30 patients (25%), comprising major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%). Patients with a BMI exceeding 35 kg/m(2) had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P = .05) than the other groups. Patients with BMI of less than 25 kg/m(2) had a greater overall complication rate than those with a BMI of 25 to 35 kg/m(2) (P < .05). Multivariate regression analysis demonstrated BMI was the only significant determinant of overall complication rates and medical complication rates (P < .05).
Patients with a BMI exceeding 35 kg/m(2) (severely obese) or a BMI of less than 25 kg/m(2) have higher rates of complication after RTSA.
体重指数（BMI）是髋关节和膝关节置换术后并发症的独立预测因素。类似趋势是否适用于接受反式全肩关节置换术（RTSA）的患者尚不清楚。
对至少随访90天的初次RTSA进行回顾性研究。并发症分为严重或轻微、内科或外科。患者分为3组：正常BMI（BMI<25kg/m²）、超重或轻度肥胖（BMI 25-35kg/m²）以及中度或重度肥胖（BMI>35kg/m²）。
119例符合纳入标准的患者中，30例（25%）BMI小于25kg/m²；65例（55%）BMI为25至35kg/m²，24例（20%）BMI超过35kg/m²。30例患者（25%）发生并发症，其中严重并发症11例（9%），轻微并发症19例（16%），外科并发症21例（18%），内科并发症14例（1）。最常见的外科并发症是需要输血的急性失血贫血（8.4%）和脱位（4.2%）。最常见的内科并发症是肺不张（2.5%）和急性肾功能不全（2.5%）。BMI超过35kg/m²的患者总体并发症发生率（P<.05）和术中失血量（P=.05）显著高于其他组。BMI小于25kg/m²的患者总体并发症发生率高于BMI为25至35kg/m²的患者（P<.05）。多因素回归分析显示BMI是总体并发症发生率和内科并发症发生率的唯一显著决定因素（P<.05）。
BMI超过35kg/m²（重度肥胖）或BMI小于25kg/m²的患者在RTSA后并发症发生率较高。
