Buzney Catherine D, Zhong Haoyan, Gulotta Lawrence V, Memtsoudis Stavros G, Liu Jiabin
Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA.
Division of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, NY, USA.
HSS J. 2022 Nov;18(4):504-511. doi: 10.1177/15563316221083251. Epub 2022 Mar 16.
Malnutrition and obesity are established predictors of complications following joint replacement surgery. However, the effect of obesity in the setting of albumin deficiency has not been explored in non-weight-bearing upper-extremity joint arthroplasty.
We sought to determine whether there is a synergistic effect between obesity and hypoalbuminemia among patients undergoing primary total shoulder arthroplasty (TSA) with respect to postoperative outcomes, including (1) mortality rates, (2) composite surgical complications, (3) length of hospitalization, and (4) hospital readmission.
We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database to find patients who underwent primary TSA from January 1, 2006, to December 31, 2019. We grouped these patients as obese (body mass index [BMI] ≥ 30 kg/m) or nonobese (BMI = 18.5-29.9 kg/m) and by serum albumin level (hypoalbuminemia < 3.5 mg/dL or normoalbuminemia ≥ 3.5 mg/dL). We gathered data on readmission and mortality rates, and NSQIP complications were organized into 3 composite variables: wound infection, systemic infection, and cardiac/pulmonary complication. For each outcome, multivariate logistic regression analysis evaluated its association with obesity and hypoalbuminemia, as well as with the interaction of BMI and albumin, while adjusting for covariates.
Of 12,881 patients, 51.8% were obese and 7.0% had hypoalbuminemia; 7.6% of obese patients had hypoalbuminemia versus 6.3% of those who were not obese. Patients with hypoalbuminemia had the longest hospital stays and the highest rates of mortality and systemic infection of all subgroups. Multivariate logistic regression analysis did not show higher complication rates due to obesity or evidence of additive interaction between hypoalbuminemia and obesity.
Unlike previous reports in weight-bearing arthroplasty, in this retrospective study of a cohort of patients who underwent TSA, we did not observe greater complications due to obesity alone, nor did we find evidence of additive interaction between obesity and hypoalbuminemia. This distinction may be due to the non-weight-bearing nature of TSA, in which excessive BMI may be less relevant for postoperative healing.
营养不良和肥胖是关节置换手术后并发症的既定预测因素。然而，在非负重上肢关节置换术中，肥胖在白蛋白缺乏情况下的影响尚未得到探讨。
我们试图确定在接受初次全肩关节置换术（TSA）的患者中，肥胖和低白蛋白血症之间是否存在协同效应，这涉及术后结果，包括（1）死亡率，（2）综合手术并发症，（3）住院时间，以及（4）再次入院情况。
我们使用国家外科质量改进计划（NSQIP）数据库进行了一项回顾性队列研究，以找出2006年1月1日至2019年12月31日期间接受初次TSA的患者。我们将这些患者分为肥胖组（体重指数[BMI]≥30kg/m）或非肥胖组（BMI = 18.5 - 29.9kg/m），并根据血清白蛋白水平（低白蛋白血症<3.5mg/dL或正常白蛋白血症≥3.5mg/dL）进行分组。我们收集了再入院率和死亡率数据，NSQIP并发症被整理为3个综合变量：伤口感染、全身感染和心肺并发症。对于每个结果，多因素逻辑回归分析评估其与肥胖和低白蛋白血症的关联，以及与BMI和白蛋白的相互作用，同时对协变量进行调整。
在12881例患者中，51.8%为肥胖患者，7.0%患有低白蛋白血症；7.6%的肥胖患者患有低白蛋白血症，而非肥胖患者为6.3%。低白蛋白血症患者的住院时间最长，在所有亚组中的死亡率和全身感染率最高。多因素逻辑回归分析未显示因肥胖导致的更高并发症发生率，也未显示低白蛋白血症与肥胖之间存在相加相互作用的证据。
与先前关于负重关节置换术的报道不同，在这项对接受TSA的患者队列的回顾性研究中，我们没有观察到仅因肥胖导致的更多并发症，也没有发现肥胖与低白蛋白血症之间存在相加相互作用的证据。这种差异可能是由于TSA的非负重性质，其中过高的BMI对术后愈合可能不太相关。
