Cheng Karen Y, Ball Scott T, Gonzales Francis B, Schenk Simon, Hughes-Austin Jan M
Department of Radiology, University of California, San Diego, San Diego, CA, USA.
Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA.
Arthroplast Today. 2020 Aug 10;6(3):571-577. doi: 10.1016/j.artd.2020.06.010. eCollection 2020 Sep.
Obesity is prevalent among patients undergoing total hip arthroplasty and has been associated with the risk of wound complications, particularly when an anterior approach is used. However, most studies have focused on obesity defined by the body mass index (BMI), without considering the metabolic effects of adiposity. Thus, in this study, we investigated the independent effects of the BMI and metabolic syndrome on wound complications after total hip arthroplasty.
Among 804 consecutive patients undergoing total hip arthroplasty between October 2013 and July 2016, we evaluated the associations between obesity (BMI ≥30 mg/kg), metabolic syndrome (defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines), and wound complication (defined as documented wound dehiscence, drainage, erythema, hematoma, infection, or seroma) over a 1-year follow-up period. We used Cox proportional hazards models adjusting for demographics, smoking status, and hospital length of stay.
Patients' mean age at time of surgery was 62.0 ± 11.9 years. Forty-seven percent were male, 27.9% were obese, and 11.6% met the definition for metabolic syndrome. Metabolic syndrome was associated with a 4-fold higher risk of wound complication (95% confidence interval: 1.4-11.1) after adjusting for all covariates including the BMI. In unadjusted analysis, obesity was associated with a higher risk of wound complication (hazard ratio: 2.8, 95% confidence interval: 1.3-6.2). However, obesity was not associated with the risk of wound complication after adjusting for the metabolic syndrome ( = .16).
Metabolic syndrome, but not obesity, defined by a BMI ≥30, was associated with wound complications, suggesting that metabolic effects of adiposity may represent a distinct risk factor in the development of wound complications from a higher BMI alone.
肥胖在接受全髋关节置换术的患者中很普遍，并且与伤口并发症的风险相关，尤其是在采用前路手术时。然而，大多数研究集中在由体重指数（BMI）定义的肥胖上，而未考虑肥胖的代谢影响。因此，在本研究中，我们调查了BMI和代谢综合征对全髋关节置换术后伤口并发症的独立影响。
在2013年10月至2016年7月期间连续接受全髋关节置换术的804例患者中，我们评估了肥胖（BMI≥30mg/kg）、代谢综合征（根据美国国家胆固醇教育计划成人治疗小组III指南定义）与伤口并发症（定义为记录在案的伤口裂开、引流、红斑、血肿、感染或血清肿）在1年随访期内的关联。我们使用Cox比例风险模型对人口统计学、吸烟状况和住院时间进行了调整。
患者手术时的平均年龄为62.0±11.9岁。47%为男性，27.9%为肥胖患者，11.6%符合代谢综合征的定义。在对包括BMI在内的所有协变量进行调整后，代谢综合征与伤口并发症风险高出4倍相关（95%置信区间：1.4-11.1）。在未调整分析中，肥胖与伤口并发症风险较高相关（风险比：2.8，95%置信区间：1.3-6.2）。然而，在对代谢综合征进行调整后，肥胖与伤口并发症风险无关（P=0.16）。
由BMI≥30定义的代谢综合征而非肥胖与伤口并发症相关，这表明肥胖的代谢影响可能是伤口并发症发生中一个独立于较高BMI的独特风险因素。
