From the Department of Sports Medicine, New England Baptist Hospital, Boston, MA (Saini, Ross, and Shah), and the New England Shoulder and Elbow Center, Brighton, MA (Bono, Li, MacAskill, Chilton, Ross, and Shah).
J Am Acad Orthop Surg. 2022 Jan 1;30(1):e67-e73. doi: 10.5435/JAAOS-D-21-00476.
The primary purpose of this study was to determine the number of patients who would be denied a complication-free total shoulder arthroplasty (TSA) based on implementation of body mass index (BMI) eligibility cutoffs.
The National Surgical Quality Improvement Program database was queried to identify all patients who underwent primary TSA. Patient demographics and 30-day postoperative complications were compared according to BMI stratification using the Pearson chi-square test and binary logistic regression analysis adjusted for age and modified Charlson comorbidity index. A BMI eligibility criterion of ≥40 kg/m2 was used to calculate the positive predictive value (PPV) to assess the number of complication-free TSAs that would be denied to avoid a complication in a single patient.
A total of 23,284 patients who underwent TSA met inclusion criteria. The overall complication rate was 7.2%. Using a BMI cutoff of ≥40 kg/m2 would yield a PPV of 7% for all Major Complications. This means that 14 complication-free procedures would be denied to avoid a Major Complication. In addition, BMI ≥40 kg/m2 served as an independent risk factor for acute renal failure, pulmonary embolism, ventilator use >48 hours, and readmission. The PPV for these clinically significant complications using BMI ≥40 kg/m2 as a cutoff was 4.9%. This translates into 20 patients being denied a complication-free procedure to avoid a single clinically significant medical complication. If this policy was enforced on the 2,426 patients who exceeded BMI ≥40 kg/m2 in this study, nearly 2,307 patients would be denied the potential benefit of surgery to prevent 119 complications.
The use of eligibility criteria for primary TSA or RSA based solely on BMI threshold values presents a potential limitation in access to care to these patients who otherwise would have a complication-free procedure.
Level III, prognostic, retrospective cohort study.
本研究的主要目的是确定根据体重指数（BMI）合格标准实施后，将有多少患者无法进行无并发症的全肩关节置换术（TSA）。
通过国家手术质量改进计划数据库，确定所有接受初次 TSA 的患者。使用 Pearson 卡方检验和二元逻辑回归分析，根据 BMI 分层比较患者人口统计学和 30 天术后并发症，调整年龄和改良 Charlson 合并症指数。使用 BMI 合格标准≥40kg/m2 来计算阳性预测值（PPV），以评估为避免单个患者发生并发症而被拒绝的无并发症 TSA 数量。
共纳入 23284 例接受 TSA 的患者，总体并发症发生率为 7.2%。使用 BMI 截断值≥40kg/m2 将使所有主要并发症的 PPV 达到 7%。这意味着将有 14 例无并发症的手术被拒绝，以避免主要并发症。此外，BMI≥40kg/m2 是急性肾衰竭、肺栓塞、呼吸机使用>48 小时和再入院的独立危险因素。BMI≥40kg/m2 作为截定点，这些有临床意义的并发症的 PPV 为 4.9%。这意味着有 20 名患者被拒绝进行无并发症的手术，以避免单一的临床显著医疗并发症。如果在本研究中超过 BMI≥40kg/m2 的 2426 名患者中实施这一政策，近 2307 名患者将被拒绝接受手术以预防 119 种并发症的潜在益处。
仅基于 BMI 阈值值的初次 TSA 或 RSA 的资格标准的使用，可能会限制这些患者获得治疗的机会，而他们本来可以进行无并发症的手术。
三级，预后，回顾性队列研究。
