From the Department of Orthopaedics, Halifax Infirmary, Halifax, NS (Richardson, Dunbar); the Department of Surgery, University of Calgary, Calgary, Alta. (Dusik); and the Department of Surgery, Dalhousie University, Halifax, NS (Lethbridge).
Can J Surg. 2021 Feb 18;64(1):E84-E90. doi: 10.1503/cjs.012719.
Obesity is an important comorbidity affecting outcomes after total joint arthroplasty. Consequently, surgeons may delay care of obese patients to first address obesity through different care pathways. The effect of obesity on patient wait times for total joint arthroplasty has not been explored. The purpose of this study was to evaluate the effect of obesity on access to total hip (THA) and knee (TKA) arthroplasty.
The study data set was constructed from the Nova Scotia Health Authority's Horizon Patient Folder system and the Patient Access Registry Nova Scotia. Wait time was measured as days between the decision to treat and date of surgery. Body mass index (BMI) was calculated from a preoperative assessment, and patients were grouped into BMI categories. Multivariate log-linear regression was used to test for statistical differences, controlling for confounding factors.
We observed longer wait times for TKA with increasing BMI weight class. Patients with BMIs greater than 50 had 34% longer waits than reference weight patients. However, THA recipients showed no statistical difference in wait times across weight categories. Furthermore, there was variability among surgeons in the wait times experienced by patients.
The finding of longer wait times for TKAs, but not THAs, among patients who were obese was unexpected. This shows the variable wait times for THA and TKA that patients who are obese can experience with different surgeons. It is important to understand the variability in wait times so that efforts to standardize the patient experience can be accomplished.
肥胖是影响全关节置换术后结局的重要合并症。因此，外科医生可能会通过不同的护理途径来首先解决肥胖问题，然后再为肥胖患者提供治疗。肥胖对全关节置换术患者等待时间的影响尚未得到探索。本研究旨在评估肥胖对全髋关节置换术（THA）和全膝关节置换术（TKA）的获得途径的影响。
研究数据集由新斯科舍省卫生当局的地平线患者文件夹系统和新斯科舍省患者准入登记处构建。等待时间是从治疗决定到手术日期之间的天数。体重指数（BMI）是根据术前评估计算的，患者被分为 BMI 类别。采用多元对数线性回归检验统计学差异，控制混杂因素。
我们观察到 BMI 体重类别增加与 TKA 的等待时间延长有关。BMI 大于 50 的患者等待时间比参考体重患者长 34%。然而，THA 受者在体重类别之间的等待时间没有统计学差异。此外，不同外科医生的患者等待时间存在差异。
肥胖患者的 TKA 等待时间比 THA 长，这一发现出人意料。这表明肥胖患者在不同外科医生处经历的 THA 和 TKA 等待时间存在差异。了解等待时间的差异非常重要，以便能够完成标准化患者体验的努力。
