Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A..
Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, U.S.A.
Arthroscopy. 2019 Mar;35(3):874-882.e3. doi: 10.1016/j.arthro.2018.10.108. Epub 2019 Feb 4.
To use the American College of Surgeons National Surgical Quality Improvement Program database to determine whether body mass index (BMI) is associated with 30-day postoperative complications following arthroscopic surgery.
Cases of elective knee, hip, and shoulder arthroscopy were identified. A retrospective comparative analysis was conducted, and the overall rates of morbidity, mortality, readmission, reoperation, and venothromboembolism (VTE) were compared using univariate analyses and binary logistic regressions to ascertain the adjusted effect of BMI, with and without diabetes, on morbidity, readmission, reoperation, and VTE.
There were 141,335 patients who met the criteria. The most common complications were deep vein thrombosis (0.27%), superficial surgical site infection (0.17%), urinary tract infection (0.13%), and pulmonary embolism (0.11%). Obesity class III with diabetes was a risk factor for morbidity (odds ratio [OR] = 1.522; 95% confidence interval [CI], 1.101-2.103) and readmission (OR = 2.342; 95% CI, 1.998-2.745) following all procedures, while obesity class I was protective toward reoperation (OR = 0.687, 95% CI, 0.485-0.973). Underweight patients were at higher risk for morbidity following shoulder arthroscopy (OR = 3.776; 95% CI, 1.605-8.883), as were the class I obese (OR = 1.421; 95% CI, 1.010-1.998) and class II obese (OR = 1.726, 95% CI, 1.159-2.569). BMI did not significantly affect morbidity following knee arthroscopy. VTE risk factors included being overweight (OR = 1.474; 95% CI, 1.088-1.996) or diabetic with class I obesity (OR = 1.469; 95% CI, 1.027-2.101).
Arthroscopic procedures are safe with very low complication rates. However, underweight and class I and class II obese patients are at higher risk for morbidity following shoulder arthroscopy, and diabetic patients with class III obesity are at higher risk for morbidity and readmission following all arthroscopy. Because BMI is a modifiable risk factor, these patients should be evaluated carefully before being considered for outpatient arthroscopic surgery.
Level III, retrospective comparative study.
利用美国外科医师学会国家外科质量改进计划数据库确定体重指数（BMI）是否与关节镜手术后 30 天的术后并发症相关。
确定了择期膝关节、髋关节和肩关节关节镜检查的病例。进行了回顾性对比分析，使用单因素分析和二元逻辑回归比较了发病率、死亡率、再入院率、再次手术率和静脉血栓栓塞症（VTE）的总体发生率，以确定 BMI 及其合并糖尿病对发病率、再入院率、再次手术率和 VTE 的调整影响。
共有 141335 名符合条件的患者。最常见的并发症是深静脉血栓形成（0.27%）、浅表手术部位感染（0.17%）、尿路感染（0.13%）和肺栓塞（0.11%）。肥胖 III 级合并糖尿病是所有手术发病率（比值比 [OR] = 1.522；95%置信区间 [CI]，1.101-2.103）和再入院率（OR = 2.342；95% CI，1.998-2.745）的危险因素，而肥胖 I 级则对再次手术有保护作用（OR = 0.687，95% CI，0.485-0.973）。体重不足的患者肩关节镜术后发病率更高（OR = 3.776；95% CI，1.605-8.883），I 级肥胖患者（OR = 1.421；95% CI，1.010-1.998）和 II 级肥胖患者（OR = 1.726，95% CI，1.159-2.569）也是如此。BMI 对膝关节镜术后发病率无显著影响。VTE 的危险因素包括超重（OR = 1.474；95% CI，1.088-1.996）或合并 I 级肥胖的糖尿病患者（OR = 1.469；95% CI，1.027-2.101）。
关节镜手术是安全的，并发症发生率非常低。然而，体重不足和 I 级和 II 级肥胖患者肩关节镜术后发病率较高，肥胖 III 级合并糖尿病患者所有关节镜术后发病率和再入院率较高。由于 BMI 是一个可改变的危险因素，这些患者在考虑门诊关节镜手术前应仔细评估。
III 级，回顾性比较研究。
