Edelstein Adam I, Lovecchio Francis, Delagrammaticas Dimitri E, Fitz David W, Hardt Kevin D, Manning David W
Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Arthroplasty. 2017 Feb;32(2):362-366. doi: 10.1016/j.arth.2016.08.007. Epub 2016 Aug 20.
The arthroplasty population increasingly presents with comorbid conditions linked to elevated risk of postsurgical complications. Current quality improvement initiatives require providers to more accurately assess and manage risk presurgically. In this investigation, we assess the effect of metabolic syndrome (MetS), as well as the effect of body mass index (BMI) within MetS, on the risk of complication following hip and knee arthroplasty.
We queried the American College of Surgeons National Surgical Quality Improvement Program database for total hip or knee arthroplasty cases. Thirty-day rates of Centers for Medicare and Medicaid Services (CMS)-reportable complications, wound complications, and readmissions were compared between patients with and without a diagnosis of MetS using multivariate logistic regression. Arthroplasty cases with a diagnosis of MetS were further stratified according to World Health Organization BMI class, and the role of BMI within the context of MetS was assessed.
Of the 107,117 included patients, 11,030 (10.3%) had MetS. MetS was significantly associated with CMS complications (odds ratio [OR] = 1.415; 95% confidence interval [CI], 1.306-1.533; P < .001), wound complications (OR = 1.749; 95% CI, 1.482-2.064; P < .001), and readmission (OR = 1.451; 95% CI, 1.314-1.602; P < .001). When MetS was assessed by individual BMI class, the MetS + BMI >40 group was associated with significantly higher risk of CMS complications, wound complications, and readmission compared to the lower MetS BMI groups.
MetS is an independent risk factor for CMS-reportable complications, wound complications, and readmission following total joint arthroplasty. The risk attributable to MetS exists irrespective of obesity class and increases as BMI increases.
接受关节置换术的人群中，合并症越来越多，这与术后并发症风险升高相关。当前的质量改进措施要求医疗服务提供者在术前更准确地评估和管理风险。在本研究中，我们评估了代谢综合征（MetS）以及MetS中的体重指数（BMI）对髋膝关节置换术后并发症风险的影响。
我们查询了美国外科医师学会国家外科质量改进计划数据库中的全髋关节或膝关节置换病例。使用多因素逻辑回归比较了诊断为MetS和未诊断为MetS的患者之间，医疗保险和医疗补助服务中心（CMS）报告的并发症、伤口并发症和再入院的30天发生率。对诊断为MetS的关节置换病例，根据世界卫生组织的BMI类别进一步分层，并评估BMI在MetS背景下的作用。
在纳入研究的107,117例患者中，11,030例（10.3%）患有MetS。MetS与CMS并发症（比值比[OR]=1.415；95%置信区间[CI]，1.306 - 1.533；P<.001）、伤口并发症（OR = 1.749；95% CI，1.482 - 2.064；P<.001）和再入院（OR = 1.451；95% CI，1.314 - 1.602；P<.001）显著相关。当按个体BMI类别评估MetS时，与MetS较低BMI组相比，MetS + BMI>40组发生CMS并发症、伤口并发症和再入院的风险显著更高。
MetS是全关节置换术后CMS报告的并发症、伤口并发症和再入院的独立危险因素。无论肥胖类别如何，MetS所致的风险均存在，且随着BMI的增加而增加。
