Wilkie Wayne A, Remily Ethan A, Mohamed Nequesha S, McDermott Scott, Shalit Bernard, Baird Andrew, Brand Kenneth, Nace James, Delanois Ronald
Orthopaedics, Lifebridge Health-Rubin Institute for Advanced Orthopedics, Baltimore, USA.
Cureus. 2020 May 4;12(5):e7955. doi: 10.7759/cureus.7955.
Introduction As morbid obesity disproportionately affects minorities and those of lower socioeconomic status, body mass index (BMI) restrictions on total hip arthroplasty (THA) may harm populations already facing disparities in care. Therefore, this study analyzed demographics and outcomes in morbidly obese primary THA patients. Methods The National Inpatient Sample was queried for THAs performed between 2009 and 2016. Of 2,676,086 patients identified, 453,250 had a BMI over 25 kg/m. Patients were stratified by BMI into overweight (BMI=25.0-29.9 kg/m), non-morbidly obese (BMI=30.0-40.0 kg/m), and morbidly obese (BMI>40.1 kg/m). Patient demographics (age, sex, race, insurance, income, and Charlson Comorbidity Index) and outcomes (length of stay [LOS], mortality, disposition, complications, charges, and costs) were assessed. Categorical and continuous data were analyzed with chi-square analyses and one-way analyses of variance, respectively. Results The number of overweight, non-morbidly obese, and morbidly obese patients increased by 299.0%, 109.3%, and 90.9%, respectively, between 2009 and 2016 (p<0.001). Morbidly obese patients were younger than non-morbidly obese and overweight patients (p<0.001) and had a higher proportion of females (p<0.001) and black patients (p<0.001). Morbidly obese patients most frequently used Medicaid and private insurance (p<0.001). Morbidly obese patients demonstrated a longer LOS, a higher mortality rate, a lower rate of home discharges and the most complications (all, p<0.001). Conclusion These results reflect the worsening obesity epidemic and may be useful in counseling preoperative weight loss to morbidly obese patients to reduce mortality and complications.
引言 由于病态肥胖对少数族裔和社会经济地位较低的人群影响尤为严重，因此对全髋关节置换术（THA）设置体重指数（BMI）限制可能会对那些在医疗保健方面已经面临差异的人群造成伤害。因此，本研究分析了病态肥胖的初次全髋关节置换术患者的人口统计学特征和手术结果。方法 对2009年至2016年间进行的全髋关节置换术的全国住院患者样本进行查询。在识别出的2676086例患者中，453250例患者的BMI超过25kg/m²。患者按BMI分层为超重（BMI = 25.0 - 29.9kg/m²）、非病态肥胖（BMI = 30.0 - 40.0kg/m²）和病态肥胖（BMI>40.1kg/m²）。评估患者的人口统计学特征（年龄、性别、种族、保险、收入和查尔森合并症指数）和手术结果（住院时间[LOS]、死亡率、出院情况、并发症、费用和成本）。分类数据和连续数据分别采用卡方分析和单因素方差分析进行分析。结果 2009年至2016年间，超重、非病态肥胖和病态肥胖患者的数量分别增加了299.0%、109.3%和90.9%（p<0.001）。病态肥胖患者比非病态肥胖和超重患者更年轻（p<0.001），女性比例更高（p<0.001），黑人患者比例更高（p<0.001）。病态肥胖患者最常使用医疗补助和私人保险（p<0.001）。病态肥胖患者的住院时间更长、死亡率更高、出院回家的比例更低，并发症最多（所有结果，p<0.001）。结论 这些结果反映了肥胖流行情况的恶化，可能有助于为病态肥胖患者提供术前减重咨询，以降低死亡率和并发症。
