接受全踝关节置换术患者的体重指数（BMI）临界值及种族、民族、性别或年龄差异
Body Mass Index (BMI) Cutoffs and Racial, Ethnic, Sex, or Age Disparities in Patients Treated With Total Ankle Arthroplasty.
作者信息
Chao Myra, Manz Wesley J, Fink Juliet, Coleman Michelle M, Kadakia Rishin J, Bariteau Jason T
机构信息
Emory University School of Medicine, Atlanta, GA, USA.
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
出版信息
Foot Ankle Orthop. 2023 Jul 18;8(3):24730114231184189. doi: 10.1177/24730114231184189. eCollection 2023 Jul.
BACKGROUND
The rising prevalence of obesity among American adults has disproportionately affected Black adults and women. Furthermore, body mass index (BMI) has historically been used as a relative contraindication to many total joint arthroplasty (TJA) procedures, including total ankle arthroplasty. The purpose of this study was to investigate potential disparities in patient eligibility for total ankle arthroplasty based on race, ethnicity, sex, and age by applying commonly used BMI cutoffs to the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
METHODS
Patients in the ACS-NSQIP database who underwent TAA from 2011 to 2020 were retrospectively reviewed in a cross-sectional analysis. BMI cutoffs of <50, <45, <40, and <35 were then applied. The eligibility rate for TAA was examined for each BMI cutoff, and findings were stratified by race, ethnicity, sex, and age. Independent tests, chi-squared tests, and Fisher exact tests were performed to compare differences at an α = 0.05.
RESULTS
A total of 1215 of 1865 TAA patients (65.1%) were included after applying the exclusion criteria. Black patients had disproportionately lower rates of eligibility at the most stringent BMI cutoff of <35 ( = .004). Hispanic patients had generally lower rates of eligibility across all BMI cutoffs. In contrast, Asian American and Pacific Islander patients had higher rates of eligibility at the BMI cutoffs of <35 ( = .033) and <40 ( = .039), and White non-Hispanic patients had higher rates of eligibility across all BMI cutoffs. Females had lower eligibility rates across all BMI cutoffs. Ineligible patients were also younger compared to eligible patients across all BMI cutoffs.
CONCLUSION
Stringent BMI cutoffs may disproportionately disqualify Black, female, and younger patients from receiving total ankle arthroplasty.
LEVEL OF EVIDENCE
Level III, retrospective cross-sectional study.
背景
美国成年人肥胖患病率的上升对黑人成年人和女性产生了不成比例的影响。此外，体重指数（BMI）在历史上一直被用作许多全关节置换术（TJA）手术的相对禁忌证，包括全踝关节置换术。本研究的目的是通过将常用的BMI临界值应用于美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，调查基于种族、族裔、性别和年龄的全踝关节置换术患者资格的潜在差异。
方法
对2011年至2020年在ACS-NSQIP数据库中接受全踝关节置换术（TAA）的患者进行回顾性横断面分析。然后应用BMI临界值<50、<45、<40和<35。检查每个BMI临界值下TAA的资格率，并按种族、族裔、性别和年龄进行分层。进行独立检验、卡方检验和Fisher精确检验，以比较α=0.05时的差异。
结果
应用排除标准后，1865例TAA患者中有1215例（65.1%）被纳入。在最严格的BMI临界值<35时，黑人患者的资格率不成比例地较低（P=0.004）。西班牙裔患者在所有BMI临界值下的资格率普遍较低。相比之下，亚裔美国人和太平洋岛民患者在BMI临界值<35（P=0.033）和<40（P=0.039）时资格率较高，非西班牙裔白人患者在所有BMI临界值下资格率较高。女性在所有BMI临界值下的资格率较低。在所有BMI临界值下，不符合资格的患者也比符合资格的患者年轻。
结论
严格的BMI临界值可能会使黑人、女性和年轻患者不成比例地失去接受全踝关节置换术的资格。
证据水平
III级，回顾性横断面研究。
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