Ling Kenny, Wang Katherine E, Kim Noah D, Komatsu David E, Wang Edward D
Department of Orthopaedics, Stony Brook University, Stony Brook, NY.
Renaissance School of Medicine at Stony Brook University, Stony Brook, NY.
J Hand Surg Glob Online. 2023 Jul 27;5(6):787-792. doi: 10.1016/j.jhsg.2023.06.015. eCollection 2023 Nov.
Carpometacarpal (CMC) arthroplasty is an effective surgical treatment to relieve pain and improve function for osteoarthritis of the CMC joint. The association between body mass index (BMI) and postoperative complications has been studied for other orthopedic procedures, including total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. However, BMI has not been studied as a risk factor for postoperative complications following CMC arthroplasty. The purpose of this study was to determine the postoperative complications associated with different categories of BMI following CMC arthroplasty. We hypothesized that increasing BMI is associated with more severe complications.
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent CMC arthroplasty between 2015 and 2020. Patient demographics, comorbidities, surgical characteristics, and 30-day postoperative complication data were collected. Patients were stratified into cohorts based on BMI as follows: underweight (BMI < 18.5 kg/m), normal/reference (18.5 kg/m ≤ BMI < 30.0 kg/m), obese (30.0 kg/m ≤ BMI < 35.0 kg/m), severely obese (35.0 kg/m ≤ BMI < 40.0 kg/m), and morbidly obese (BMI ≥ 40.0 kg/m). Multivariate logistic regression was used to identify postoperative complications associated with each cohort.
In total, 6,432 patients were included in this study: 3,622 (56.3%) patients were included in the normal/reference cohort, 77 (1.2%) patients were included in the underweight cohort, 1,479 (23.0%) patients were included in the obese cohort, 718 (11.2%) patients were included in the severely obese cohort, and 536 (8.3%) patients were included in the morbidly obese cohort. The obese cohort was independently associated with a higher rate of superficial incisional surgical-site infection (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.00-4.44; = .050). The morbidly obese cohort was independently associated with readmission (OR, 3.35; 95% CI, 1.15-9.74; = .026) and reoperation (OR, 3.40; 95% CI, 1.04-1.11; = .043).
Morbid obesity is a clinically significant predictor for readmission and reoperation within 30 days following CMC arthroplasty. Obesity is a clinically significant predictor for superficial incisional surgical-site infection within 30 days following CMC arthroplasty.
A better understanding of BMI as a risk factor for postoperative complications may allow surgeons to improve preoperative risk stratification and patient counseling.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
腕掌关节（CMC）置换术是缓解CMC关节骨关节炎疼痛并改善功能的一种有效手术治疗方法。体重指数（BMI）与术后并发症之间的关联已在包括全膝关节置换术、全髋关节置换术和全肩关节置换术在内的其他骨科手术中进行了研究。然而，BMI尚未作为CMC置换术后并发症的危险因素进行研究。本研究的目的是确定CMC置换术后与不同BMI类别相关的术后并发症。我们假设BMI增加与更严重的并发症相关。
查询美国外科医师学会国家外科质量改进计划数据库中2015年至2020年间接受CMC置换术的所有患者。收集患者的人口统计学资料、合并症、手术特征和术后30天并发症数据。患者根据BMI分层如下：体重过轻（BMI<18.5kg/m²）、正常/参考值（18.5kg/m²≤BMI<30.0kg/m²）、肥胖（30.0kg/m²≤BMI<35.0kg/m²）、重度肥胖（35.0kg/m²≤BMI<40.0kg/m²）和病态肥胖（BMI≥40.0kg/m²）。采用多因素logistic回归确定与每个队列相关的术后并发症。
本研究共纳入6432例患者：正常/参考值队列纳入3622例（56.3%）患者，体重过轻队列纳入77例（1.2%）患者，肥胖队列纳入1479例（23.0%）患者，重度肥胖队列纳入718例（11.2%）患者，病态肥胖队列纳入536例（8.3%）患者。肥胖队列与浅表切口手术部位感染发生率较高独立相关（比值比[OR]，2.11；95%置信区间[CI]，1.00 - 4.44；P = 0.050）。病态肥胖队列与再次入院（OR，3.35；95%CI，1.15 - 9.74；P = 0.026）和再次手术（OR，3.40；95%CI，1.04 - 1.11；P = 0.043）独立相关。
病态肥胖是CMC置换术后30天内再次入院和再次手术的具有临床意义的预测因素。肥胖是CMC置换术后30天内浅表切口手术部位感染的具有临床意义的预测因素。
更好地理解BMI作为术后并发症的危险因素可能使外科医生改善术前风险分层和患者咨询。
研究类型/证据水平：预后性III级。
