Whiting P S, White-Dzuro G A, Avilucea F R, Dodd A C, Lakomkin N, Obremskey W T, Collinge C A, Sethi M K
Department of Orthopaedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave., Madison, WI, 53705, USA.
The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
Eur J Trauma Emerg Surg. 2017 Apr;43(2):255-264. doi: 10.1007/s00068-016-0642-0. Epub 2016 Feb 15.
The impact of obesity on outcomes has been documented extensively in the elective orthopaedic literature, but little is known about the impact of obesity on outcomes following orthopaedic trauma surgery. Utilizing the ACS-NSQIP database, we sought to investigate the relationship between BMI and perioperative complications in orthopaedic trauma patients.
53,219 orthopaedic trauma patients were identified using a CPT code search between 2005 and 2013 in the NSQIP database. Patient demographics, and perioperative complications (including minor, major, and total) were collected. Multivariate regression analysis was performed to control for baseline demographics and comorbidities.
Compared with patients of normal weight, underweight patients had significantly greater odds of minor [OR 1.12, 95 % CI (1.0, 1.26), p = 0.04], major [OR 1.20, 95 % CI (1.1, 1.3), p = 0.0009], and total complications [OR 1.18, 95 % CI (1.1, 1.3), p = 0.0003]. Morbidly obese patients had significantly greater odds of major [OR 1.22, 95 % CI (1.0, 1.5), p = 0.023] and total complications [OR 1.18, 95 % CI (1.0, 1.4), p = 0.023] compared to normal weight patients. When wound-related complications were examined independently, obesity was associated with increased odds of superficial [OR 1.67, 95 % CI (1.3, 2.1), p < 0.0001] and deep wound infection [OR 1.52, 95 % CI (1.075, 2.144), p = 0.018], and morbid obesity was associated with increased odds of wound dehiscence [OR 2.29, 95 % CI (1.1, 4.9), p = 0.034] and deep infection [OR 2.51, 95 % CI (1.6, 3.9), p < 0.0001].
Morbidly obese patients have significantly greater odds of wound dehiscence, deep wound infection, major complications, and total complications compared to patients of normal weight. Additionally, BMI under 18.5 is associated with increased odds of minor, major, and total perioperative complications. Interventions aimed at decreasing complication rates should be targeted at these high-risk patient populations on both ends of the BMI spectrum.
肥胖对择期骨科手术预后的影响在骨科文献中已有广泛记载，但肥胖对骨科创伤手术后预后的影响却知之甚少。利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，我们试图研究体重指数（BMI）与骨科创伤患者围手术期并发症之间的关系。
通过在NSQIP数据库中使用现行程序编码（CPT）搜索，确定了2005年至2013年间的53219例骨科创伤患者。收集了患者的人口统计学资料和围手术期并发症（包括轻微、严重和总体并发症）。进行多变量回归分析以控制基线人口统计学和合并症。
与正常体重患者相比，体重过轻的患者发生轻微并发症的几率显著更高[比值比（OR）为1.12，95%置信区间（CI）为（1.0，1.26），p = 0.04]、严重并发症[OR为1.20，95%CI为（1.1，1.3），p = 0.0009]和总体并发症[OR为1.18，95%CI为（1.1，1.3），p = 0.0003]。与正常体重患者相比，病态肥胖患者发生严重并发症[OR为1.22，95%CI为（1.0，1.5），p = 0.023]和总体并发症[OR为1.18，95%CI为（1.0，1.4），p = 0.023]的几率显著更高。当独立检查与伤口相关的并发症时，肥胖与浅表伤口感染几率增加[OR为1.67，95%CI为（1.3，2.1），p < 0.0001]和深部伤口感染[OR为1.52，95%CI为（1.075，2.144），p = 0.018]相关，病态肥胖与伤口裂开几率增加[OR为2.29，95%CI为（1.1，4.9），p = 0.034]和深部感染[OR为2.51，95%CI为（1.6，3.9），p < 0.0001]相关。
与正常体重患者相比，病态肥胖患者发生伤口裂开、深部伤口感染、严重并发症和总体并发症的几率显著更高。此外，BMI低于18.5与围手术期轻微、严重和总体并发症几率增加相关。旨在降低并发症发生率的干预措施应针对BMI范围两端的这些高危患者群体。
