Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A..
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.
Arthroscopy. 2019 Jan;35(1):121-129. doi: 10.1016/j.arthro.2018.07.032.
To understand the effect of obesity on operative times and 30-day readmission rates after arthroscopic anterior cruciate ligament reconstruction (ACLR).
The American College of Surgeons National Surgical Quality Improvement Program database was queried using Current Procedural Terminology billing codes to identify all patients aged 18 years and older who underwent ACLR between 2007 and 2014. The Student t test was used for continuous variables, and the χ-square or Fisher exact test was used for categorical variables. Multivariate analysis was conducted to identify factors associated with 30-day readmission.
We identified 9,000 patients who underwent ACLR. In the readmission analysis, the total readmission rate was 0.70%. After multivariate analysis, a body mass index (BMI) of 40 or greater was associated with a significantly increased risk of 30-day readmission (odds ratio, 3.06; 95% confidence interval, 1.09-8.57). An operative time of less than 80 minutes was associated with a decreased risk of readmission (odds ratio, 0.40, 95% confidence interval, 0.18-0.92). In the operative-time analysis, the mean operative time was 100.7 minutes. Older age was predictive of decreasing operative time, with the operative time being 32.75 minutes shorter in patients aged 65 years or older than in those younger than 25 years. After multivariate analysis, class II obesity (BMI of 35-39.9) predicted an increase of 7.11 minutes and class III obesity (BMI ≥ 40) predicted an increase of 8.70 minutes compared with normal weight (BMI of 18.5-24.9).
Obesity is associated with longer operative times and increased 30-day readmissions after ACLR, with patients with a BMI of 40 or greater having over 3 times the risk of readmission compared with patients with a normal weight. Male sex, black race, and younger age are all also associated with increased operative times.
Level III, observational, retrospective cohort study.
了解肥胖对关节镜前交叉韧带重建（ACLR）术后手术时间和 30 天再入院率的影响。
使用美国外科医师学会国家手术质量改进计划数据库，根据当前手术术语计费代码，检索 2007 年至 2014 年间接受 ACLR 的所有 18 岁及以上患者。采用学生 t 检验比较连续变量，采用卡方检验或 Fisher 确切概率法比较分类变量。采用多变量分析确定与 30 天再入院相关的因素。
我们共纳入 9000 例接受 ACLR 的患者。在再入院分析中，总再入院率为 0.70%。多变量分析后，BMI 为 40 或更高与 30 天再入院风险显著增加相关（比值比，3.06；95%置信区间，1.09-8.57）。手术时间小于 80 分钟与再入院风险降低相关（比值比，0.40；95%置信区间，0.18-0.92）。在手术时间分析中，平均手术时间为 100.7 分钟。年龄较大与手术时间缩短相关，与 25 岁以下患者相比，65 岁及以上患者的手术时间缩短 32.75 分钟。多变量分析后，II 级肥胖（BMI 为 35-39.9）预计会增加 7.11 分钟，III 级肥胖（BMI≥40）预计会增加 8.70 分钟，而与正常体重（BMI 为 18.5-24.9）相比。
肥胖与 ACLR 术后手术时间延长和 30 天再入院率增加相关，BMI 为 40 或更高的患者再入院风险是正常体重患者的 3 倍以上。男性、黑人和年轻也是手术时间延长的相关因素。
III 级，观察性、回顾性队列研究。
