Aggarwal Vikram A, Sambandam Senthil, Wukich Dane
Orthopaedics, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2022 Jul 29;14(7):e27450. doi: 10.7759/cureus.27450. eCollection 2022 Jul.
Aim Previous research has shown that obesity is associated with worse postoperative outcomes. We aim to determine how rates of specific complications after total hip arthroplasty (THA) align with obesity status. We hypothesize that obese patients would have higher rates of complications and cost and thus have worse outcomes than non-obese patients. Methods Data were collected from a large commercial insurance database between 2011 and 2020. Patients underwent a hip replacement under current procedural terminology (CPT) and International Statistical Classification of Diseases (ICD-9/ICD-10) codes. Obese (defined as having a BMI of 30 kg/m or higher) and non-obese patients were matched on age, gender, Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Standardized complications and costs in one year were compared using unequal variance t-tests. Results Under CPT codes, 61,462 obese (45% male) and 61,462 non-obese patients (45% male) underwent a hip replacement. Obese patients had significantly higher rates of surgical site infection (SSI) (OR=1.193, p=0.0001), deep vein thrombosis (DVT) (OR=1.275, p=0.001), wound complication (OR=1.736, p<0.0001), hematoma (OR=1.242, p=0.0001), pulmonary embolism (OR=1.141, p=0.0355), UTI (OR=1.065, p=0.0016), and opioid prescriptions (OR=1.17, p<0.0001), and significantly lower rates of arrhythmia (OR=0.907, p<0.0001), congestive heart failure (CHF) (OR=0.863, p<0.0001), cardiac arrest (OR=0.637 p<0.0001), pneumonia (OR=0.795, p<0.0001), and transfusion (OR=0.777, p<0.0001). Furthermore, obese patients were significantly more likely to undergo revision within 10 years (OR=1.172, p<0.0001). Under ICD codes, 31,922 obese (45% male) and 31,922 non-obese patients (45% male) were included. Obese patients did not have a significant difference in total cost or drug cost. Conclusions Obese patients had significantly higher rates of infection, venous thromboembolic event, wound complication, hematoma, and opioid prescriptions but significantly lower rates of cardiac issues, pneumonia, and transfusion, after hip replacement. Additionally, there was no significant difference in total or drug cost. Therefore, this study did not support our hypothesis that obese patients have worse outcomes than non-obese patients, as there neither was a clear significant increase in complication rates nor a significant increase in costs. However, further research should be done to better understand the complex relationship between obesity and postoperative outcomes.
目的 先前的研究表明，肥胖与术后较差的预后相关。我们旨在确定全髋关节置换术（THA）后特定并发症的发生率与肥胖状况之间的关系。我们假设肥胖患者的并发症发生率和费用会更高，因此其预后比非肥胖患者更差。方法 收集了2011年至2020年期间一个大型商业保险数据库中的数据。患者根据当前程序术语（CPT）和国际疾病分类（ICD - 9/ICD - 10）代码接受了髋关节置换术。肥胖（定义为体重指数BMI为30kg/m或更高）和非肥胖患者在年龄、性别、查尔森合并症指数（CCI）和埃利克斯豪泽合并症指数（ECI）方面进行了匹配。使用不等方差t检验比较了一年内的标准化并发症和费用。结果 根据CPT代码，61462名肥胖患者（45%为男性）和61462名非肥胖患者（45%为男性）接受了髋关节置换术。肥胖患者的手术部位感染（SSI）发生率显著更高（OR = 1.193，p = 0.0001）、深静脉血栓形成（DVT）（OR = 1.275，p = 0.001）、伤口并发症（OR = 1.736，p < 0.0001）、血肿（OR = 1.242，p = 0.0001）、肺栓塞（OR = 1.141，p = 0.0355）、尿路感染（UTI）（OR = 1.065，p = 0.0016）和阿片类药物处方（OR = 1.17，p < 0.0001），而心律失常（OR = 0.907，p < 0.0001）、充血性心力衰竭（CHF）（OR = 0.863，p < 0.0001）、心脏骤停（OR = 0.637，p < 0.0001）、肺炎（OR = 0.795，p < 0.0001）和输血（OR = 0.777，p < 0.0001）的发生率显著更低。此外，肥胖患者在10年内进行翻修的可能性显著更高（OR = 1.172，p < 0.0001）。根据ICD代码，纳入了31922名肥胖患者（45%为男性）和31922名非肥胖患者（45%为男性）。肥胖患者的总费用或药物费用没有显著差异。结论 肥胖患者在髋关节置换术后感染、静脉血栓栓塞事件、伤口并发症、血肿和阿片类药物处方的发生率显著更高，但心脏问题、肺炎和输血的发生率显著更低。此外，总费用或药物费用没有显著差异。因此，本研究不支持我们的假设，即肥胖患者的预后比非肥胖患者更差，因为并发症发生率既没有明显显著增加，费用也没有显著增加。然而，应该进行进一步的研究以更好地理解肥胖与术后预后之间的复杂关系。
