Mundi Raman, Nucci Nicholas, Wolfstadt Jesse, Pincus Daniel, Chaudhry Harman
Sunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, M4Y 1H1, Canada.
Division of Orthopaedic Surgery, University of Ottawa, Ottawa, ON, K1H 8L6, Canada.
Arthroplasty. 2023 Feb 2;5(1):6. doi: 10.1186/s42836-022-00162-3.
Patients with a high body-mass index (BMI) are at increased risk for significant complications after total knee arthroplasty (TKA). We explored whether operative time is a modifiable risk factor for infectious and thromboembolic complications.
A retrospective observational cohort study of the ACS-NSQIP registry, including all patients who underwent primary TKA (2015-2018), and were morbidly obese (BMI 40 kg/m or greater) was performed. We created four categories of operative time in minutes: less than 60, 60-90, 91-120, and greater than 120. The association of prolonged operative time with superficial/deep surgical site infection (SSI), DVT and PE within 30 days postoperatively was evaluated using multivariate logistic regression.
34,190 patients were included (median age 63 [IQR 57-68], mean BMI of 44.6 kg/m [SD 4.4]). The majority of patients had an operative time between 60-90 mins (n = 13,640, 39.9%) or 91-120 mins (n = 9908, 29.0%). There was no significant association between longer operative time and superficial/deep/organ-space SSI or PE. DVT risk was significantly increased. Patients with time exceeding 120 mins had nearly 2.5 greater odds of DVT compared to less than 60 minutes (OR 2.47, 95% CI: 1.39-4.39, P = 0.002). Odds of DVT were 1.73 times greater in those with time of 91-120 mins (OR 1.73, 95%CI: 0.98-3.05, P = 0.06).
Early infection and thromboembolic complications with prolonged operative time in morbidly obese patients remain low. We did not identify a significant association with increased operative time and superficial/deep SSI, or PE. There was a significantly increased risk for deep vein thrombosis with prolonged operative time.
体重指数（BMI）较高的患者在全膝关节置换术（TKA）后发生严重并发症的风险增加。我们探讨了手术时间是否是感染和血栓栓塞并发症的一个可改变的风险因素。
对美国外科医师学会国家外科质量改进计划（ACS-NSQIP）登记处进行一项回顾性观察队列研究，纳入所有接受初次TKA（2015 - 2018年）且病态肥胖（BMI为40kg/m²或更高）的患者。我们将手术时间分为四类（以分钟计）：少于60分钟、60 - 90分钟、91 - 120分钟和大于120分钟。使用多因素逻辑回归评估延长的手术时间与术后30天内浅表/深部手术部位感染（SSI）、深静脉血栓形成（DVT）和肺栓塞（PE）之间的关联。
共纳入34190例患者（中位年龄63岁[四分位间距57 - 68岁]，平均BMI为44.6kg/m²[标准差4.4]）。大多数患者的手术时间在60 - 90分钟之间（n = 13640，39.9%）或91 - 120分钟之间（n = 9908，29.0%）。手术时间延长与浅表/深部/器官间隙SSI或PE之间无显著关联。DVT风险显著增加。与手术时间少于60分钟的患者相比，手术时间超过120分钟的患者发生DVT的几率高出近2.5倍（比值比[OR]2.47，95%置信区间[CI]：1.39 - 4.39，P = 0.002）。手术时间为91 - 120分钟的患者发生DVT的几率是其1.73倍（OR 1.73，95%CI：0.98 - 3.05，P = 0.06）。
病态肥胖患者手术时间延长时早期感染和血栓栓塞并发症发生率仍较低。我们未发现手术时间延长与浅表/深部SSI或PE增加之间存在显著关联。手术时间延长会使深静脉血栓形成风险显著增加。
