Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Arthroplasty. 2018 Oct;33(10):3281-3287. doi: 10.1016/j.arth.2018.02.073. Epub 2018 Feb 26.
Obesity has previously been demonstrated to be an independent risk factor for increased complications after total hip and knee arthroplasties (THA and TKA). The purpose of this study was to compare the effects of obesity and body mass index (BMI) to determine whether the magnitude of the effect was similar for both procedures.
We queried the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent primary THA or TKA between 2010 and 2014. Patients were stratified by procedure and classified as nonobese, obese, or morbidly obese according to BMI. Thirty-day rates of wound complications, deep infection, total complications, and reoperation were compared using univariate and multivariate logistic regression analyses.
We identified 64,648 patients who underwent THA and 97,137 patients who underwent TKA. Obese THA patients had significantly higher rates of wound complications (1.53% vs 0.96%), deep infection (0.31% vs 0.17%), reoperation rate (2.11% vs 1.02%), and total complications (5.22% vs 4.63%) compared with TKA patients. Morbidly obese patients undergoing THA were also found to have significantly higher rates of wound complications (3.25% vs 1.52%), deep infection (0.84% vs 0.23%), reoperation rate (3.65% vs 1.60%), and total complications (7.36% vs 5.57%). Multivariate regression analysis identified increasingly higher odds of each outcome measure as BMI increased.
This study demonstrates that the impact of obesity on postoperative complications is more profound for THA than TKA. This emphasizes the importance of considering patient comorbidities in the context of the specific procedure when assessing risks of surgery.
肥胖先前已被证明是全髋关节和膝关节置换术（THA 和 TKA）后并发症增加的独立危险因素。本研究的目的是比较肥胖和体重指数（BMI）的影响，以确定两种手术的影响程度是否相似。
我们查询了美国外科医师学会国家手术质量改进计划数据库，以确定 2010 年至 2014 年间接受初次 THA 或 TKA 的患者。根据手术方式将患者分层，并根据 BMI 将患者分为非肥胖、肥胖或病态肥胖。使用单变量和多变量逻辑回归分析比较 30 天伤口并发症、深部感染、总并发症和再次手术的发生率。
我们确定了 64648 例接受 THA 和 97137 例接受 TKA 的患者。肥胖的 THA 患者的伤口并发症发生率（1.53%比 0.96%）、深部感染率（0.31%比 0.17%）、再次手术率（2.11%比 1.02%）和总并发症发生率（5.22%比 4.63%）明显高于 TKA 患者。接受 THA 的病态肥胖患者的伤口并发症发生率（3.25%比 1.52%）、深部感染率（0.84%比 0.23%）、再次手术率（3.65%比 1.60%）和总并发症发生率（7.36%比 5.57%）也明显更高。多变量回归分析确定随着 BMI 的增加，每种结果测量的可能性增加。
本研究表明，肥胖对 THA 术后并发症的影响比对 TKA 更为严重。这强调了在评估手术风险时，根据具体手术考虑患者合并症的重要性。
