Tollemar Viktor C, Olsen Eric, McHugh Michael, Muscatelli Stefano R, Gagnier Joel J, Tarnacki Laura, Hallstrom Brian R
Department of Orthopaedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
University of Michigan Medical School, Ann Arbor, MI, USA.
Arthroplast Today. 2022 Aug 19;17:74-79. doi: 10.1016/j.artd.2022.07.018. eCollection 2022 Oct.
Obesity is associated with increased complications after total joint arthroplasty (TJA), leading some surgeons to recommend nutrition counseling and weight loss. We aim to evaluate the effect of preoperative nutritionist referral on weight loss and likelihood of surgery in obese patients seeking primary TJA.
A retrospective cohort of patients seeking primary TJA who were referred to a licensed nutritionist for weight loss was matched by age, sex, and body mass index (BMI) to an unreferred control group. BMI change was compared between groups up to 1 year of follow-up. Differences were determined using 2-tailed t-tests and chi-squared tests with a significance cutoff of < .05.
A total of 274 referred patients and 174 controls were included in our analysis. Patients who were referred to a nutritionist achieved significantly greater average BMI change (-1.5 kg/m) than controls (-0.8 kg/m) by 6 months after first contact ( = .01) although significance was lost at 1 year after first contact ( = .21). Thirty-eight percent of referred patients went on to TJA compared with 28% of controls ( < .01).
Referral to a licensed nutritionist modestly improves early weight loss and is associated with a higher rate of surgery in obese patients seeking primary TJA.
肥胖与全关节置换术（TJA）后并发症增加相关，这使得一些外科医生建议进行营养咨询和减肥。我们旨在评估术前转介营养师对寻求初次TJA的肥胖患者体重减轻及手术可能性的影响。
将寻求初次TJA且被转介至有执照营养师处进行减肥的患者的回顾性队列，按年龄、性别和体重指数（BMI）与未被转介的对照组进行匹配。在长达1年的随访期间比较两组之间的BMI变化。使用双侧t检验和卡方检验确定差异，显著性临界值为<.05。
我们的分析共纳入了274例被转介患者和174例对照组。被转介至营养师处的患者在首次接触后6个月时平均BMI变化（-1.5kg/m²）显著大于对照组（-0.8kg/m²）（P =.01），不过在首次接触后1年时显著性消失（P =.21）。38%的被转介患者继续接受TJA，而对照组为28%（P <.01）。
转介至有执照营养师处适度改善了早期体重减轻情况，且与寻求初次TJA的肥胖患者更高的手术率相关。
