London Daniel A, Stepan Jeffrey G, Lalchandani Gopal R, Okoroafor Ugochi C, Wildes Troy S, Calfee Ryan P
Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO; Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO; Department of Orthopedic Surgery, St. Louis University School of Medicine, St. Louis, MO; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO; Department of Anesthesiology, Washington University in St. Louis School of Medicine, St. Louis, MO; Department of Orthopedic Surgery, St. Louis University School of Medicine, St. Louis, MO; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH.
J Hand Surg Am. 2014 Aug;39(8):1578-84. doi: 10.1016/j.jhsa.2014.05.007. Epub 2014 Jun 27.
To compare the rates of postoperative complications in obese and nonobese patients following elbow, forearm, and hand surgeries.
This case-control study examined 436 patients whose body mass index (BMI) was over 35 and who underwent hand, wrist, forearm, or elbow surgery between 2009 and 2013. Controls were patients (n = 433) with a BMI less than 30 who had similar surgeries over the same period, and who were frequency-matched by type of surgery (ie, bony, soft tissue, or nerve), age, and sex. Postoperative complications were defined as infection requiring antibiotic or reoperation, delayed incision healing, nerve dysfunction, wound dehiscence, hematoma, and other reoperation. Medical comorbidities (e.g., hypertension, diabetes, stroke, vascular disease, kidney disease, and liver disease) were recorded. Chi-square analyses were performed to explore the association between obesity and postoperative complications. Similar analyses were performed stratified by surgery type and BMI classification. Logisticregression modeling was performed to identify predictors of postoperative complications accounting for surgery type, BMI, the presence of comorbidities, patient age, and patient sex. This same model was also run separately for case and control patients.
The overall complication rate was 8.7% with similar rates between obese and nonobese patients (8.5% vs. 9.0%). Bony procedures resulted in the greatest risk of complication in both groups (15% each group). Multivariate analysis confirmed surgery type as the only significant predictor of complications for nonobese patients. However, among obese patients, both bony surgery and increasing BMI were associated with greater complication rates.
Not all obese patients appear to be at any higher risk for complications after elbow, forearm, and hand surgery compared with nonobese patients. However, there appears to be a dose-dependent effect of BMI among obese patients such that increasing obesity heightens the risk of complications, especially for those with a BMI greater than 45.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
比较肥胖和非肥胖患者在肘部、前臂和手部手术后的术后并发症发生率。
本病例对照研究纳入了436例体重指数（BMI）超过35且在2009年至2013年间接受手部、腕部、前臂或肘部手术的患者。对照组为433例BMI小于30的患者，他们在同一时期接受了类似手术，且根据手术类型（即骨手术、软组织手术或神经手术）、年龄和性别进行了频率匹配。术后并发症定义为需要抗生素治疗或再次手术的感染、切口愈合延迟、神经功能障碍、伤口裂开、血肿以及其他再次手术情况。记录了合并症（如高血压、糖尿病、中风、血管疾病、肾脏疾病和肝脏疾病）。进行卡方分析以探讨肥胖与术后并发症之间的关联。按手术类型和BMI分类进行了类似分析。进行逻辑回归建模以确定术后并发症的预测因素，同时考虑手术类型、BMI、合并症的存在、患者年龄和患者性别。该模型也分别对病例组和对照组患者进行了运行。
总体并发症发生率为8.7%，肥胖和非肥胖患者的发生率相似（8.5%对9.0%）。两组中骨手术导致的并发症风险最高（每组15%）。多变量分析证实手术类型是非肥胖患者并发症的唯一显著预测因素。然而，在肥胖患者中，骨手术和BMI增加均与更高的并发症发生率相关。
与非肥胖患者相比，并非所有肥胖患者在肘部、前臂和手部手术后出现并发症的风险都更高。然而，肥胖患者中似乎存在BMI的剂量依赖性效应，即肥胖程度增加会增加并发症风险，尤其是对于BMI大于45的患者。
研究类型/证据水平：预后性II级。
