From the College of Medicine, University of Florida, Gainesville, FL (Hones, Hao, and Cueto), the Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL (Jonathan O. Wright, King, and Thomas W. Wright), the Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC (Friedman), and the Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL (Schoch).
J Am Acad Orthop Surg. 2023 Nov 15;31(22):1165-1172. doi: 10.5435/JAAOS-D-23-00122. Epub 2023 Sep 1.
An inverse relationship coined the "obesity paradox" has been propositioned, in which body mass index (BMI) may be contradictorily protective in patients undergoing surgery or treatment of chronic disease. This study sought to investigate the BMI associated with the lowest rate of medical complications after total shoulder arthroplasty (TSA).
The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adults who underwent elective primary TSA between January 2012 and December 2020. Thirty-day postoperative medical complications were extracted, which included death, readmission, pneumonia, pulmonary embolism, renal failure, and cardiac arrest, among others. BMI was classified into five categories (underweight [BMI <18.5 kg/m 2 ], normal weight [BMI ≥18.5 and <25 kg/m 2 ], overweight [BMI ≥25 and <30 kg/m 2 ], obese [BMI ≥30 and <40 kg/m 2 ], and morbidly obese [BMI ≥40 kg/m 2 ]). We examined the risk of any 30-day postoperative complications and BMI categorically and on a continuous basis using multivariable logistic regression controlling for age, sex, procedure year, and comorbidities.
Of the 31,755 TSAs, 84% were White, 56% were female, and the average age of patients was 69.2 ± 9.3 years. Thirty-day postoperative medical complications occurred in 4.53% (n = 1,440). When assessed on a continuous basis, the lowest risk was in patients with a BMI between 30 and 35 kg/m 2 . Underweight individuals (BMI <18.5 kg/m 2 ) had the highest postoperative complication rates overall. The probability of medical complications increased with age and was greater for female patients.
The relationship between BMI and complication risk in TSA is nonlinear. A BMI between 30 and 35 kg/m 2 was associated with the lowest risk of medical complications after TSA, and BMI<18.5 kg/m 2 had the highest risk overall, indicating some protective aspects of BMI against 30-day medical complications. Thus, obesity alone should not preclude patients from TSA eligibility, rather surgical candidacy should be evaluated in the context of patients' overall health and likelihood of benefit from TSA.
III, Retrospective Comparative Study.
有人提出了一种相反的关系，即“肥胖悖论”，即在接受手术或治疗慢性疾病的患者中，体重指数（BMI）可能具有矛盾的保护作用。本研究旨在调查与全肩关节置换术后（TSA）医疗并发症发生率最低相关的 BMI。
美国外科医师学院国家手术质量改进计划数据库被查询，以确定 2012 年 1 月至 2020 年 12 月期间接受择期初次 TSA 的成年人。提取术后 30 天的医疗并发症，包括死亡、再入院、肺炎、肺栓塞、肾衰竭和心脏骤停等。BMI 分为五类（体重不足[BMI<18.5kg/m2]、正常体重[BMI≥18.5 且<25kg/m2]、超重[BMI≥25 且<30kg/m2]、肥胖[BMI≥30 且<40kg/m2]和病态肥胖[BMI≥40kg/m2]）。我们使用多变量逻辑回归控制年龄、性别、手术年份和合并症，对任何 30 天术后并发症和 BMI 进行分类和连续评估。
在 31755 例 TSA 中，84%为白人，56%为女性，患者平均年龄为 69.2±9.3 岁。术后 30 天发生医疗并发症的比例为 4.53%（n=1440）。连续评估时，BMI 在 30 至 35kg/m2 之间的患者风险最低。体重不足（BMI<18.5kg/m2）的患者总体术后并发症发生率最高。随着年龄的增长，医疗并发症的发生概率增加，女性患者的发生率更高。
TSA 中 BMI 与并发症风险之间的关系是非线性的。BMI 在 30 至 35kg/m2 之间与 TSA 后医疗并发症风险最低相关，而 BMI<18.5kg/m2 总体风险最高，这表明 BMI 对 30 天医疗并发症有一定的保护作用。因此，肥胖本身不应排除患者接受 TSA 的资格，而应根据患者的整体健康状况和从 TSA 中获益的可能性来评估手术适应证。
III，回顾性比较研究。
