2008 - 2016年全髋关节置换术患者肥胖患病率趋势及其对手术结果的影响
Trends in obesity prevalence among total hip arthroplasty patients and the effect on surgical outcomes, 2008-2016.
作者信息
Pirruccio Kevin, Sloan Matthew, Sheth Neil P
机构信息
Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA.
出版信息
J Orthop. 2019 Apr 7;16(4):347-352. doi: 10.1016/j.jor.2019.03.024. eCollection 2019 Jul-Aug.
INTRODUCTION
The prevalence of obesity continues to rise in parallel with demand for total hip arthroplasty (THA). This study aims to report obesity trends in primary THA and its effects on procedure outcomes in the United States, stratifying based on Body Mass Index (BMI).
METHODS
Primary THA procedures were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database (2008-2016). Patient demographic (including BMI), primary outcomes (death; serious morbidity), and secondary outcome variables were analyzed. Using BMI comparison groups (Obese: BMI > 30 [O]; Morbidly Obese: BMI > 40 [MO]) for case populations, univariate, propensity score-matched, and multivariate logistic regression analyses were performed.
RESULTS
The prevalence of obesity increased among primary THA (2008: 546/1200 [45.5%], 2016: 16,078/34,137 [47.1%]) cases. Data on 135,013 primary THA cases were analyzed. Propensity score-matched analyses demonstrated that both serious morbidity (O: OR = 0.73, p < 0.001; MO: OR = 0.84, p = 0.001) and frequency of discharges home (O: OR = 0.90, p < 0.001; MO: OR = 0.71, p < 0.001) were significantly reduced. Instead, long operative times (O: OR = 1.30, p < 0.001; MO: OR = 1.53, p < 0.001), readmission (O: OR = 1.27, p < 0.001; MO: OR = 1.49, p < 0.001), and reoperation (O: OR = 1.44, p < 0.001, MO: OR = 1.96, p < 0.001) were all significantly increased in both obese and morbidly obese cases. Death (OR = 0.29; p = 0.016) was decreased in the MO cohort, while length of stay (OR = 1.19, p = 0.004) was increased in the MO cohort.
CONCLUSION
Both obese and morbidly obese primary THA patient populations were associated with variably increased complication risks; morbidly obese patients had higher complication rates relative to obese patients. Orthopaedic surgeons should continue to consider obesity as a risk factor for THA complications. However, given similar functional outcomes and satisfaction levels as non-obese patients, denying patients THA surgery based on BMI alone may merit reconsideration.
引言
肥胖症的患病率与全髋关节置换术（THA）的需求同步持续上升。本研究旨在报告美国初次全髋关节置换术中肥胖症的趋势及其对手术结果的影响，并根据体重指数（BMI）进行分层。
方法
在美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库（2008 - 2016年）中识别初次全髋关节置换术病例。分析患者人口统计学特征（包括BMI）、主要结局（死亡；严重并发症）和次要结局变量。针对病例人群使用BMI比较组（肥胖：BMI > 30 [O]；病态肥胖：BMI > 40 [MO]），进行单因素、倾向评分匹配和多因素逻辑回归分析。
结果
初次全髋关节置换术病例中肥胖症的患病率有所增加（2008年：546/1200 [45.5%]，2016年：16,078/34,137 [47.1%]）。分析了135,013例初次全髋关节置换术病例的数据。倾向评分匹配分析表明，严重并发症（O：OR = 0.73，p < 0.001；MO：OR = 0.84，p = 0.001）和出院回家频率（O：OR = 0.90，p < 0.001；MO：OR = 0.71，p < 0.001）均显著降低。相反，肥胖和病态肥胖病例的手术时间延长（O：OR = 1.30，p < 0.001；MO：OR = 1.53，p < 0.001）、再入院（O：OR = 1.27，p < 0.001；MO：OR = 1.49，p < 0.001）和再次手术（O：OR = 1.44，p < 0.001，MO：OR = 1.96，p < 0.001）均显著增加。MO队列中的死亡（OR = 0.29；p = 0.016）有所降低，而MO队列中的住院时间（OR = 1.19，p = 0.004）有所增加。
结论
肥胖和病态肥胖的初次全髋关节置换术患者群体均与不同程度增加的并发症风险相关；病态肥胖患者相对于肥胖患者的并发症发生率更高。骨科医生应继续将肥胖视为全髋关节置换术并发症的危险因素。然而，鉴于与非肥胖患者相似的功能结局和满意度水平，仅基于BMI拒绝患者进行全髋关节置换术手术可能值得重新考虑。
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