Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Orthopaedic Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA.
Bone Joint J. 2020 Jun;102-B(6_Supple_A):31-35. doi: 10.1302/0301-620X.102B6.BJJ-2019-1509.R1.
Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Some risk factors are more modifiable than others, and some conditions considered modifiable such as obesity may not be as modifiable in the setting of advanced arthritis as many propose. We sought to determine whether controlling for hypoalbuminaemia would mitigate the effect that prior authors had identified in patients with obesity.
We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the period of January 2008 to December 2016 to evaluate the rates of reoperation and readmission within 30 days following primary TKA. Multivariate logistic regression modelling controlled for preoperative albumin, age, sex, and comorbidity status.
Readmission rates only differed significantly between patients with Normal Weight and Obesity Class II, with a decreased rate of readmission in this group (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.71 to 0.96; p = 0.010). The only group demonstrating association with increased risk of reoperation within 30 days was the Obesity Class III group (OR 1.38; 95% CI 1.05 to 1.82; p = 0.022). Hypoalbuminaemia (preoperative albumin < 35 g/L) was significantly associated with readmission (OR 1.62; 95% CI 1.41 to 1.86; p < 0.001) and reoperation (OR 1.52; 95% CI 1.18 to 1.96; p = 0.001) within 30 days.
In this study, hypoalbuminaemia appears to be a more significant risk factor for readmission and reoperation than even the highest obesity categories. Future studies may assess whether preoperative albumin restoration or weight loss may improve outcomes for patients with hypoalbuminaemia. The implications of this study may allow surgeons to discuss risk of surgery with obese patients planning to undergo primary TKA procedures if other comorbidities are adequately controlled. Cite this article: 2020;102-B(6 Supple A):31-35.
由于新的支付模式对初次全膝关节置换术（TKA）后的再入院和再手术率进行了严格审查，这些负面结果受到了关注。一些风险因素比其他因素更具可操作性，而一些被认为是可改变的因素，如肥胖，在晚期关节炎患者中可能并不像许多人所认为的那样具有可操作性。我们试图确定在患有肥胖症的患者中，控制低蛋白血症是否会减轻先前作者所确定的影响。
我们回顾了美国外科医师学会国家手术质量改进计划（ACS-NSQIP）数据库，以评估 2008 年 1 月至 2016 年 12 月期间初次 TKA 后 30 天内再次手术和再入院的发生率。多变量逻辑回归模型控制了术前白蛋白、年龄、性别和合并症状态。
仅在体重正常和肥胖 II 类患者之间，再入院率有显著差异，该组的再入院率降低（比值比（OR）0.82；95%置信区间（CI）0.71 至 0.96；p = 0.010）。唯一与 30 天内再次手术风险增加相关的组是肥胖 III 类组（OR 1.38；95%CI 1.05 至 1.82；p = 0.022）。低蛋白血症（术前白蛋白<35 g/L）与 30 天内再入院（OR 1.62；95%CI 1.41 至 1.86；p<0.001）和再手术（OR 1.52；95%CI 1.18 至 1.96；p = 0.001）显著相关。
在这项研究中，低蛋白血症似乎是再入院和再手术的一个比最高肥胖类别更重要的危险因素。未来的研究可能会评估术前白蛋白恢复或减肥是否可以改善低蛋白血症患者的手术结果。本研究的意义在于，如果其他合并症得到充分控制，外科医生可以与计划接受初次 TKA 手术的肥胖患者讨论手术风险。引用本文：2020；102-B（6 增刊 A）：31-35。
