Anakwenze Oke, Fokin Alex, Chocas Mary, Dillon Mark T, Navarro Ronald A, Yian Edward H, Singh Anshuman
Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA, USA.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
J Shoulder Elbow Surg. 2017 Jul;26(7):1230-1237. doi: 10.1016/j.jse.2016.11.055. Epub 2017 Jan 30.
The purpose of this study was to identify the effects of body mass index (BMI) on long-term outcomes (revision rate, 1-year mortality rate, 3-year surgical site infection rate, and 90-day inpatient all-cause readmission rate) after total shoulder arthroplasty (TSA) and reverse TSA (RTSA).
A large shoulder arthroplasty registry was used to review outcomes after TSA and RTSA. The registry monitors patient's revision, mortality, infection, and readmission rates. The exposure of interest was the patient's BMI at the time of the surgery, which was stratified by 5 kg/m increments.
Selected for this study were 4630 patients who underwent TSA and RTSA between 2007 and 2013, of which 3483 (75.2%) were TSA and 1147 (24.8%) were RTSA. The overall combined (TSA and RTSA) revision rate was 1.7%. After adjusting for confounders in the overall models (TSA and RTSA combined), higher BMI was not associated with higher risk of aseptic revision, 1-year mortality, or 3-year deep infection. In TSA-specific models, every 5 kg/m increase in BMI was marginally associated with a 16% increase in the likelihood of 90-day readmission. This association was not observed in the RTSA model. In RTSA-specific models, every 5 kg/m increase in BMI was marginally associated with higher risk of 3-year deep infection. This association was not observed in the TSA model.
Shoulder arthroplasty in obese patients is not associated with higher risk of aseptic revision. The BMI has different effects on TSA and RSA. The surgeon should anticipate increased risk of readmission after TSA and infection after RSA.
本研究的目的是确定体重指数（BMI）对全肩关节置换术（TSA）和反式全肩关节置换术（RTSA）后长期结局（翻修率、1年死亡率、3年手术部位感染率和90天住院全因再入院率）的影响。
使用一个大型肩关节置换术登记系统来回顾TSA和RTSA后的结局。该登记系统监测患者的翻修、死亡率、感染率和再入院率。感兴趣的暴露因素是手术时患者的BMI，按每5 kg/m²递增进行分层。
本研究选取了2007年至2013年间接受TSA和RTSA的4630例患者，其中3483例（75.2%）为TSA，1147例（24.8%）为RTSA。总体联合（TSA和RTSA）翻修率为1.7%。在总体模型（TSA和RTSA联合）中调整混杂因素后，较高的BMI与无菌性翻修、1年死亡率或3年深部感染的较高风险无关。在TSA特异性模型中，BMI每增加5 kg/m²与90天再入院可能性增加16%略有相关。在RTSA模型中未观察到这种关联。在RTSA特异性模型中，BMI每增加5 kg/m²与3年深部感染的较高风险略有相关。在TSA模型中未观察到这种关联。
肥胖患者的肩关节置换术与无菌性翻修的较高风险无关。BMI对TSA和RSA有不同影响。外科医生应预期TSA后再入院风险增加以及RSA后感染风险增加。
