Thornqvist Catharina, Gislason Gunnar H, Køber Lars, Jensen Per Føge, Torp-Pedersen Christian, Andersson Charlotte
Department of Orthopedic Surgery , Aabenraa Hospital.
Acta Orthop. 2014 Sep;85(5):456-62. doi: 10.3109/17453674.2014.934184. Epub 2014 Jun 23.
Obesity is a risk factor for osteoarthritis in the lower limb, yet the cardiovascular risks associated with obesity in hip or knee replacement surgery are unknown. We examined associations between body mass index (BMI) and the risk of a major adverse cardiovascular event (MACE: ischemic stroke, acute myocardial infarction, or cardiovascular death) or the risk of all-cause mortality in a nationwide Danish cohort of patients who underwent primary hip or knee replacement surgery.
Using Danish nationwide registries, we identified 34,744 patients aged ≥ 20 years who underwent elective primary hip or knee replacement surgery between 2005 and 2011. We used multivariable Cox regression models to calculate the 30-day risks of MACE and mortality associated with 5 BMI groups (underweight (BMI < 18.5 kg/m(2)), normal weight (18.5-24 kg/m(2)), overweight (25-29 kg/m(2)), obese 1 (30-34 kg/m(2)), and obese 2 (≥ 35 kg/m(2))).
In total, 232 patients (0.7%) had a MACE and 111 (0.3%) died. Compared with overweight, adjusted hazard ratios (HRs) were 1.2 (95% CI: 0.4-3.3), 1.3 (0.95-1.8), 1.6 (1.1-2.2), and 1.0 (0.6-1.9) for underweight, normal weight, obese 1, and obese 2 regarding MACE. Regarding mortality, the corresponding HRs were 7.0 (2.8-15), 2.0 (1.2-3.2), 1.5 (0.9-2.7), and 1.9 (0.9-4.2). Cubic splines suggested a significant U-shaped relationship between BMI and risks with nadir around 27-28.
In an unselected cohort of patients undergoing elective primary hip or knee replacement surgery, U-shaped risks of perioperative MACE and mortality were found in relation to BMI. Patients within the extreme ranges of BMI may warrant further attention.
肥胖是下肢骨关节炎的一个危险因素，但在髋关节或膝关节置换手术中，与肥胖相关的心血管风险尚不清楚。我们在丹麦一个全国性队列中，研究了接受初次髋关节或膝关节置换手术的患者的体重指数（BMI）与主要不良心血管事件（MACE：缺血性中风、急性心肌梗死或心血管死亡）风险或全因死亡风险之间的关联。
利用丹麦全国性登记处的数据，我们确定了34744名年龄≥20岁、在2005年至2011年间接受择期初次髋关节或膝关节置换手术的患者。我们使用多变量Cox回归模型计算与5个BMI组（体重过轻（BMI<18.5kg/m²）、正常体重（18.5-24kg/m²）、超重（25-29kg/m²）、肥胖1级（30-34kg/m²）和肥胖2级（≥35kg/m²））相关的30天MACE风险和死亡风险。
共有232名患者（0.7%）发生MACE，111名患者（0.3%）死亡。与超重相比，体重过轻、正常体重、肥胖1级和肥胖2级患者发生MACE的校正风险比（HR）分别为1.2（95%CI：0.4-3.3）、1.3（0.95-1.8）、1.6（1.1-2.2）和1.0（0.6-1.9）。关于死亡率，相应的HR分别为7.0（2.8-15）、2.0（1.2-3.2）、1.5（0.9-2.7）和1.9（0.9-4.2）。三次样条曲线表明BMI与风险之间存在显著的U型关系，最低点在27-28左右。
在一个未经过筛选的接受择期初次髋关节或膝关节置换手术的患者队列中，发现围手术期MACE风险和死亡风险与BMI呈U型关系。BMI处于极端范围的患者可能需要进一步关注。
