Mukka Sebastian, Rolfson Ola, Mohaddes Maziar, Sayed-Noor Arkan
Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University, Umeå, Sweden.
Swedish Hip Arthroplasty Register, Centre of Registers, Gothenburg, Sweden.
JB JS Open Access. 2020 Dec 18;5(4). doi: 10.2106/JBJS.OA.20.00100. eCollection 2020 Oct-Dec.
Overweight status and obesity represent a global epidemic, with serious consequences at the individual and community levels. The number of total hip arthroplasties (THAs) among overweight and obese patients is expected to rise. Increasing body mass index (BMI) has been associated with a higher risk of mortality and reoperation and lower implant survival. The evaluation of perioperative health-related quality of life (HRQoL) has recently gained importance because of its direct relation to, and impact on, patients' physical, mental, and social well-being as well as health-service utilization. We sought to evaluate the influence of BMI class on HRQoL preoperatively and at 1 year following THA in a register-based cohort study.
This observational cohort study was designed and conducted on the basis of registry data derived from the Swedish Hip Arthroplasty Register (SHAR) and included 64,055 primary THAs registered between January 1, 2008, and December 31, 2015. Patients' baseline preoperative and 1-year postoperative EuroQol-5 Dimension-3 Level (EQ-5D-3L) responses were documented by the treating department and reported to the SHAR through the patient-reported outcome measures program. The EQ-5D-3L includes a visual analogue scale (EQ VAS), which measures the patient's overall health status.
At 1 year of follow-up, all BMI classes showed significant and clinically relevant improvements in all HRQoL measures compared with preoperative assessment (p < 0.05). Patients reported improved perception of current overall health status for the EQ VAS. Underweight, overweight, and all obesity classes showed increasingly worse 1-year HRQoL compared with normal weight, both with unadjusted and adjusted calculations.
In this study, we found that all BMI classes had significant improvement in HRQoL at 1 year following THA. Patients who were underweight, overweight, or obese (classes I to III), compared with those of normal weight, reported worse hip pain and EQ-5D-3L and EQ VAS responses prior to THA and at 1 year postoperatively. These results can assist both health-care providers and patients in establishing reasonable expectations about THA outcomes.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
超重和肥胖是一种全球流行疾病，在个人和社区层面都有严重后果。超重和肥胖患者的全髋关节置换术（THA）数量预计将会增加。体重指数（BMI）的增加与更高的死亡风险、再次手术风险以及更低的植入物存活率相关。围手术期健康相关生活质量（HRQoL）的评估最近变得越发重要，因为它与患者的身体、心理和社会福祉以及医疗服务利用直接相关且有影响。我们试图在一项基于登记的队列研究中评估BMI类别对THA术前及术后1年HRQoL的影响。
这项观察性队列研究是基于从瑞典髋关节置换登记处（SHAR）获取的登记数据设计并开展的，纳入了2008年1月1日至2015年12月31日期间登记的64,055例初次THA。治疗科室记录患者术前基线及术后1年的欧洲五维健康量表-3水平（EQ-5D-3L）反应，并通过患者报告结局测量项目报告给SHAR。EQ-5D-3L包括一个视觉模拟量表（EQ VAS），用于测量患者的整体健康状况。
在随访1年时，与术前评估相比，所有BMI类别在所有HRQoL指标上均显示出显著且具有临床意义的改善（p < 0.05）。患者报告EQ VAS对当前整体健康状况的感知有所改善。与正常体重相比，体重过轻、超重以及所有肥胖类别在未调整和调整计算时，1年HRQoL均显示出越来越差的情况。
在本研究中，我们发现所有BMI类别在THA术后1年时HRQoL均有显著改善。与正常体重患者相比，体重过轻、超重或肥胖（I至III级）的患者在THA术前及术后1年报告的髋关节疼痛、EQ-5D-3L和EQ VAS反应更差。这些结果可帮助医疗服务提供者和患者对THA结果建立合理预期。
预后III级。有关证据水平的完整描述，请参阅作者指南。
