Revelt Nicolas, Sleiman Anthony, Kurcz Brian, George Edgar, Kleinsmith Rebekah, Feibel Benjamin, Thuppal Sowmyanarayanan, Delfino Kristin, Allan D Gordon
Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA.
Center for Clinical Research, Southern Illinois University School of Medicine, Springfield, IL, USA.
Arthroplast Today. 2024 Jul 20;28:101465. doi: 10.1016/j.artd.2024.101465. eCollection 2024 Aug.
Body mass index (BMI) is an imperfect measure of patients' adiposity and operative risk. Radiographic and direct subcutaneous measurements have been utilized in attempts to more accurately characterize the risk of postoperative complications, including surgical site infection. This study aims to evaluate whether direct tissue depth measurement is a more accurate predictor of skin complication following direct anterior total hip arthroplasty (THA).
A retrospective chart review of patients who underwent elective THA between April 30, 2020, and January 31, 2023, was performed. Baseline demographics, antibiotics, anticoagulation, and intraoperatively measured tissue depths at proximal, middle, and distal portions of the incision were recorded. Patient follow-up was reviewed to assess the development of skin complication in the acute postoperative period.
Data were collected from 280 patients who underwent THA via direct anterior approach by a single surgeon. The mean age was 66.0 years, and 52.1% were female. A total of 18/280 (6.4%) patients developed an abrasion (5/18) or superficial surgical site infection (13/18) within the first 60 days postoperatively. Patients who developed skin complications had a significantly higher BMI (33.7 kg/m vs 29.9 kg/m; = .0021). Patients with a BMI >30 kg/m had more than 5 times increased odds of developing a superficial skin complication in the acute 60-day postoperative period compared to those with a BMI <30 kg/m (Odds ratio = 5.318, = .0059). None of the measured tissue depths, nor their average together, were shown to be significant predictors of skin complications.
This study showed that BMI is a significant predictor of acute skin complications in direct anterior THA patients. No other significant predictors were found to be associated with increased risk, including proximal, middle, and distal tissue depths.
体重指数（BMI）并非衡量患者肥胖程度和手术风险的理想指标。为了更准确地描述术后并发症（包括手术部位感染）的风险，人们采用了影像学测量和直接皮下测量的方法。本研究旨在评估直接组织深度测量是否能更准确地预测直接前路全髋关节置换术（THA）后皮肤并发症的发生情况。
对2020年4月30日至2023年1月31日期间接受择期THA的患者进行回顾性病历审查。记录患者的基线人口统计学资料、抗生素使用情况、抗凝情况以及术中在切口近端、中部和远端测量的组织深度。对患者进行随访，以评估术后急性期皮肤并发症的发生情况。
收集了由一名外科医生采用直接前路进行THA的280例患者的数据。患者平均年龄为66.0岁，女性占52.1%。共有18/280（6.4%）例患者在术后60天内出现擦伤（5/18）或浅表手术部位感染（13/18）。发生皮肤并发症的患者BMI显著更高（33.7kg/m² 对29.9kg/m²；P = 0.0021）。与BMI<30kg/m² 的患者相比，BMI>30kg/m² 的患者在术后60天急性期发生浅表皮肤并发症的几率增加了5倍以上（优势比 = 5.318，P = 0.0059）。所测量的组织深度及其平均值均未显示为皮肤并发症的显著预测因素。
本研究表明，BMI是直接前路THA患者急性皮肤并发症的重要预测指标。未发现其他与风险增加相关的显著预测因素，包括近端、中部和远端组织深度。
