Department of Orthopaedic Surgery, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, Virginia.
Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, Roanoke, Virginia.
J Arthroplasty. 2023 Jul;38(7S):S78-S82.e4. doi: 10.1016/j.arth.2023.03.048. Epub 2023 Mar 24.
The American Association of Hip and Knee Surgeons tasked a 2013 workgroup to provide obesity-related recommendations in total joint arthroplasty. Morbidly obese patients (body mass index (BMI) ≥ 40) seeking hip arthroplasty were determined to be at increased perioperative risk, and surgeons were recommended to encourage these patients to reduce their BMI <40 presurgery. We report the effect of instituting a 2014 BMI <40 threshold on our primary total hip arthroplasties (THAs).
We queried our institutional database to select all primary THAs from January 2010 to May 2020. There were 1,383 THAs that were pre-2014 and 3,273 THAs that were post-2014. The 90-day emergency department (ED) visits, readmissions, and returns to operating room (OR) were identified. Patients were propensity score weight-matched according to comorbidities, age, initial surgical consultation (consult) BMI, and sex. We conducted 3 comparisons: A) pre-2014 patients who had a consult and surgical BMI ≥40 against post-2014 patients who had a consult BMI ≥40 and surgical BMI <40; B) pre-2014 patients against post-2014 patients who had a consult and surgical BMI <40; and C) post-2014 patients who had a consult BMI ≥40 and surgical BMI <40 against post-2014 patients who had a consult BMI ≥40 and surgical BMI ≥40.
Post-2014 patients who had a consult BMI ≥ 40 and surgical BMI <40 had less ED visits (7.6 versus 14.1%, P = .0007), but similar readmissions (11.9 versus 6.3%, P = .22) and returns to OR (5.4 versus 1.6%, P = .09) compared to pre-2014 patients who had a consult BMI and surgical BMI ≥ 40. Post-2014 BMI <40 had less readmissions (5.9 versus 9.3%, P < .0001), and similar all-cause returns to OR and ED visits than patients pre-2014. Post-2014 patients who had a consult and surgical BMI ≥ 40 had lower readmissions (12.5 versus 12.8%, P = .05), and similar ED visits and returns to OR than consult BMI ≥ 40 and surgical BMI <40.
Patient optimization prior to total joint arthroplasty is critical. However, the BMI optimization that mitigates risk in primary total knee arthroplasty may not apply to primary THA. We observed a paradoxical increased readmission rate for patients who reduced their BMI before THA.
III.
美国髋关节和膝关节外科医师协会责成一个 2013 年的工作组提供与全关节置换术相关的肥胖建议。接受髋关节置换术的病态肥胖患者（体重指数（BMI）≥40）被认为围手术期风险增加，建议外科医生鼓励这些患者在术前将 BMI 降低至<40。我们报告了 2014 年 BMI<40 阈值对我们初次全髋关节置换术（THA）的影响。
我们查询了我们的机构数据库，以选择 2010 年 1 月至 2020 年 5 月期间的所有初次 THA。有 1383 例 THA 是在 2014 年之前进行的，有 3273 例 THA 是在 2014 年之后进行的。确定了 90 天的急诊部（ED）就诊、再入院和返回手术室（OR）的情况。根据合并症、年龄、初次手术咨询（咨询）BMI 和性别，对患者进行倾向评分体重匹配。我们进行了 3 项比较：A）咨询和手术 BMI≥40 的 2014 年之前的患者与咨询 BMI≥40 和手术 BMI<40 的 2014 年之后的患者；B）2014 年之前的患者与咨询和手术 BMI<40 的 2014 年之后的患者；C）咨询和手术 BMI≥40 的 2014 年之后的患者与咨询和手术 BMI≥40 的 2014 年之后的患者。
咨询 BMI≥40 且手术 BMI<40 的 2014 年之后的患者 ED 就诊次数较少（7.6%比 14.1%，P=0.0007），但再入院率（11.9%比 6.3%，P=0.22）和返回 OR 率（5.4%比 1.6%，P=0.09）与咨询 BMI 和手术 BMI≥40 的 2014 年之前的患者相似。2014 年 BMI<40 的患者再入院率较低（5.9%比 9.3%，P<.0001），全因返回 OR 和 ED 就诊率与 2014 年之前的患者相似。咨询和手术 BMI≥40 的 2014 年之后的患者再入院率较低（12.5%比 12.8%，P=0.05），ED 就诊率和返回 OR 率与咨询 BMI≥40 且手术 BMI<40 的患者相似。
在进行全关节置换术前对患者进行优化是至关重要的。然而，在全膝关节置换术中降低风险的 BMI 优化可能不适用于初次 THA。我们观察到一个矛盾的现象，即那些在 THA 前降低 BMI 的患者的再入院率增加。
III。
