Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A..
Department of Orthopedics, University of California at San Francisco, San Francisco, California, U.S.A.
Arthroscopy. 2019 Mar;35(3):741-746. doi: 10.1016/j.arthro.2018.10.136. Epub 2019 Jan 29.
The goal of this study is to analyze postoperative complications after shoulder arthroscopy stratified by body mass index (BMI) and to quantify the trade-off in postsurgical complications and access to care that occurs with BMI eligibility cutoffs.
Patients who underwent shoulder arthroscopy in the National Surgical Quality Improvement Program database from 2015 to 2016 were identified. Patients were categorized on the basis of their BMI. χ tests were used to identify differences in complication rates between different BMI categories. Logistic regression was used to calculate the odds ratio of having a major complication by BMI category. The positive predictive value (PPV) was calculated at different BMI cutoffs.
There were 26,509 shoulder arthroscopy cases identified in the National Surgical Quality Improvement Program database with 383 major complications, for an overall rate of 1.4%. Patients with a BMI >40 had a higher overall complication rate (2.3% vs 1.4%, P = .001), as well as higher rates of readmission (P = .012), pneumonia (P = .030), progressive renal insufficiency (P = .006), and cardiac arrest (P = .008). BMI >40 was associated with an increased risk of major complications (odds ratio, 1.84; confidence interval, 1.29-2.61). A BMI cutoff of 40 would avoid 12% of major complications while excluding 8% of complication-free surgeries. At a BMI cutoff of 40, the PPV was 2.3% where 43 surgeries would be denied for every complication avoided.
Patients with a BMI >40 have a statistically significant but only slightly increased risk of 30-day complications after shoulder arthroscopy. Instituting a BMI eligibility cutoff at 40 has a low PPV and would prevent 43 complication-free surgeries from proceeding for every complication prevented. Patients should be counseled individually about their risk factors, but denial of shoulder arthroscopy on the basis of BMI alone may not be an appropriate strategy for risk reduction.
Level III, comparative prognostic trial.
本研究旨在分析按体重指数（BMI）分层的肩关节镜术后并发症，并量化 BMI 合格标准切点所带来的术后并发症和获得治疗机会之间的权衡。
从 2015 年至 2016 年，在国家手术质量改进计划数据库中确定接受肩关节镜手术的患者。根据 BMI 将患者分类。使用 χ2 检验比较不同 BMI 类别之间的并发症发生率差异。使用逻辑回归计算 BMI 类别下发生主要并发症的优势比。计算不同 BMI 截止值下的阳性预测值（PPV）。
在国家手术质量改进计划数据库中，共确定了 26509 例肩关节镜手术病例，其中有 383 例出现严重并发症，总体发生率为 1.4%。BMI＞40 的患者总体并发症发生率更高（2.3%比 1.4%，P=0.001），且再入院率（P=0.012）、肺炎（P=0.030）、进行性肾功能不全（P=0.006）和心脏骤停（P=0.008）的发生率更高。BMI＞40 与发生主要并发症的风险增加相关（优势比，1.84；95%置信区间，1.29-2.61）。BMI 截止值为 40 可避免 12%的主要并发症，但会排除 8%无并发症的手术。在 BMI 截止值为 40 时，PPV 为 2.3%，即每避免一次并发症，就有 43 例手术被拒绝。
BMI＞40 的患者肩关节镜术后 30 天内出现并发症的风险虽有统计学意义，但仅略有增加。设定 BMI 合格标准为 40 会导致 PPV 较低，且每避免一次并发症，就会有 43 例无并发症的手术被拒绝。应根据患者的具体情况为其提供风险咨询，但仅凭 BMI 拒绝肩关节镜手术可能不是降低风险的合适策略。
III 级，比较预后试验。
