Center for Total Joint Replacement, Department of Orthopedic Surgery, Palo Alto Medical Foundation, Palo Alto, CA.
Palo Alto Medical Foundation Research Institute, Palo Alto, CA.
J Arthroplasty. 2020 Sep;35(9):2652-2657. doi: 10.1016/j.arth.2020.04.018. Epub 2020 Apr 11.
Previous studies have addressed the increased risk of perioperative complications in the obese and morbidly obese populations undergoing total hip arthroplasty. Over the last 15 years, the direct anterior approach has increased in popularity. The purpose of this study is to compare the 90-day perioperative complication rate of total hip arthroplasty performed through the direct anterior approach stratified by body mass index (BMI).
Perioperative complications both intraoperative and up to 90 days postoperative were identified in a case series of 1808 primary total hip arthroplasties performed through a direct anterior approach. The patients were stratified according to BMI. Demographics of age, side, sex, and American Society of Anesthesiologists score were recorded. Medical and surgical complications including National Surgical Quality Improvement Program complications, length of stay, reoperation rate, readmission rate, and length of operation were recorded. Bivariate analysis and analysis of variance were performed.
Morbidly obese patients (BMI > 40) demonstrated increased American Society of Anesthesiologists scores, increased surgical times with statistically significant increase in number of patients with surgical complications, National Surgical Quality Improvement Program complications, deep infection, and wound breakdown. Grading the severity of complications also demonstrated the morbidly obese had a higher risk of experiencing more severe complications. Underweight patients (BMI < 18.5) demonstrated a statistically significant readmission rate.
In stratifying patients undergoing the direct anterior approach for total hip arthroplasty by BMI, a greater rate of surgical complications both in number and in severity occurs with the morbidly obese undergoing total hip arthroplasty through a direct anterior approach.
先前的研究已经探讨了在接受全髋关节置换术的肥胖和病态肥胖人群中，围手术期并发症风险增加的问题。在过去的 15 年中，直接前入路的应用越来越普及。本研究的目的是比较通过直接前入路行全髋关节置换术的患者，按体重指数（BMI）分层的 90 天围手术期并发症发生率。
对 1808 例通过直接前入路行初次全髋关节置换术的病例系列进行了围手术期并发症（包括术中及术后 90 天内）的回顾性分析。患者根据 BMI 进行分层。记录了年龄、侧别、性别和美国麻醉医师协会评分等人口统计学资料。记录了包括国家外科质量改进计划（NSQIP）并发症、住院时间、再次手术率、再入院率和手术时间在内的医疗和手术并发症。进行了单变量分析和方差分析。
病态肥胖患者（BMI＞40）的美国麻醉医师协会评分较高，手术时间较长，手术并发症、NSQIP 并发症、深部感染和伤口裂开的患者数量也明显增加。对并发症严重程度的分级也表明，病态肥胖患者发生更严重并发症的风险更高。体重不足患者（BMI＜18.5）的再入院率明显升高。
在按 BMI 对接受直接前入路全髋关节置换术的患者进行分层时，病态肥胖患者的手术并发症发生率更高，无论是在数量上还是在严重程度上。
