Katakam Akhil, Melnic Christopher M, Bragdon Charles R, Sauder Nicholas, Collins Austin K, Bedair Hany S
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, MA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
J Arthroplasty. 2021 Jan;36(1):72-77. doi: 10.1016/j.arth.2020.07.055. Epub 2020 Jul 29.
Malnutrition is a devastating condition which disproportionally affects the elderly population. Malnutrition furthers the pre-existing elevated risk for osteoarthritis in this population, thus exacerbating joint damage in patients and furthering the need for total joint arthroplasty (TJA). A marker for malnutrition is a low body mass index (BMI). The purpose of this study is to investigate whether low BMI status increased the risk for 2-year mortality or reoperation, 90-day readmission, or extended length of stay (LOS) following TJA.
A retrospective study was performed using the Partners Arthroplasty Registry which contains data from 2016 to 2019. The registry was queried for primary total hip and primary total knee arthroplasty (TKA) patients that had a minimum of 2-years follow-up data. Demographic, surgical, and clinical outcome variables were obtained from these patients. The association between underweight BMI and objective outcomes of reoperation, 90-day readmission, mortality, and LOS was evaluated by univariate analysis followed by multiple logistic and linear regression analyses.
The final cohort used for analysis consisted of 4802 TJA cases. After accounting for potential confounders, underweight BMI was found to be independently associated with increased risk of mortality within 2 years following TJA (odds ratio 8.77) (95% confidence interval 2.14-32.0) and increased LOS of 0.44 days (95% confidence interval 0.02-0.86).
Our findings demonstrate that TJA patients with an underweight BMI experience an 8 times increased risk of 2-year mortality and an increased LOS of 0.44 days. Orthopedic surgeons should consider nutritional consultation and medical optimization in these high-risk patients prior to surgery.
营养不良是一种极具破坏性的状况，对老年人群的影响尤为严重。营养不良会加剧该人群中原本就较高的骨关节炎风险，从而加重患者的关节损伤，并进一步增加全关节置换术（TJA）的需求。营养不良的一个标志是低体重指数（BMI）。本研究的目的是调查低BMI状态是否会增加TJA术后2年死亡率、再次手术风险、90天再入院率或延长住院时间（LOS）。
使用 Partners 关节置换登记处进行了一项回顾性研究，该登记处包含2016年至2019年的数据。查询该登记处以获取至少有2年随访数据的初次全髋关节置换术和初次全膝关节置换术（TKA）患者。从这些患者中获取人口统计学、手术和临床结局变量。通过单因素分析，随后进行多因素逻辑回归和线性回归分析，评估体重过轻的BMI与再次手术、90天再入院、死亡率和LOS等客观结局之间的关联。
用于分析的最终队列包括4802例TJA病例。在考虑潜在混杂因素后，发现体重过轻的BMI与TJA术后2年内死亡风险增加（比值比8.77）（95%置信区间2.14 - 32.0）以及住院时间延长0.44天（95%置信区间0.02 - 0.86）独立相关。
我们的研究结果表明，BMI体重过轻的TJA患者2年死亡率风险增加8倍，住院时间延长0.44天。骨科医生在手术前应考虑对这些高危患者进行营养咨询和医学优化。
