Anoushiravani Afshin A, Sayeed Zain, Chambers Monique C, Gilbert Theodore J, Scaife Steven L, El-Othmani Mouhanad M, Saleh Khaled J
Albany Medical College, Albany, New York.
Chicago Medical School, North Chicago, Illinois.
J Arthroplasty. 2016 Jul;31(7):1407-12. doi: 10.1016/j.arth.2015.12.053. Epub 2016 Feb 27.
Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists.
Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05.
Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities.
Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.
营养不良是一种可预防的状况，常与低体重指数（BMI）相关。本研究的目的是比较分析低BMI（≤19 kg/m²）和正常BMI（19 - 24.9 kg/m²）队列，探讨BMI、术后结局和资源利用之间是否存在相关性。
本研究使用了2006 - 2012年全国住院患者样本的出院数据。总共3550例全髋关节置换术（THA）和1315例全膝关节置换术（TKA）患者样本被分为两个队列，即体重过轻（≤19 kg/m²）和正常BMI（19 - 24.9 kg/m²）队列。使用埃利克斯豪泽合并症指数，所有队列在27种合并症方面进行匹配。然后对队列中的术后院内结局和资源利用进行比较分析。使用SAS软件进行多变量分析和卡方检验。显著性设定为P < 0.05。
接受THA的体重过轻患者发生术后贫血和心脏并发症的风险较高。此外，体重过轻患者发生术后感染的风险降低。体重过轻的THA队列在住院时间和住院费用方面的资源利用均更高。同样，在体重过轻的TKA队列中，观察到发生血肿/血清肿和术后贫血的风险更大。体重过轻的TKA患者住院费用更高，且更有可能被转至专业护理机构。
我们的结果表明，低BMI患者更有可能出现术后并发症和更高的资源利用。这有助于骨科医生更好地预测患者结局，并改进旨在帮助不同患者群体的治疗途径。
