Kim Billy I, Khilnani Tyler K, LaValva Scott M, Goodman Susan M, Della Valle Alejandro G, Lee Gwo-Chin
Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, New York.
Hospital for Special Surgery, Department of Rheumatology, New York, New York.
J Arthroplasty. 2024 Dec 9. doi: 10.1016/j.arth.2024.12.008.
Morbid obesity negatively affects outcomes after total hip arthroplasty (THA). The optimal strategy for weight loss before THA has not been identified. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have become increasingly popular as an effective pharmacologic weight loss agent. The goal of this study was to evaluate the effect of perioperative GLP-1 RA use in patients who have morbid obesity undergoing primary THA on postoperative outcomes.
Using an administrative claims database, patients who had morbid obesity (body mass index [BMI] ≥ 40.0) undergoing primary THA were identified. Patients who had morbid obesity and GLP-1 RA use for three months before and after surgery (treatment) were matched to patients who had morbid obesity without GLP-1 RA use (control) and to a comparison group of patients who had severe obesity (BMI = 35.0 to 39.9) in a 1:4:4 ratio, resulting in 771, 3,084, and 3,084 patients in the treatment, control, and severe obesity comparison group, respectively. Overall group differences in 90-day and 2-year postoperative outcomes were compared using univariable tests, followed by post hoc pairwise testing and P-value adjustment.
Patients who had morbid obesity on GLP-1 RA had a significantly lower rate of 90-day periprosthetic joint infection (1.6 versus 3.2%; P = 0.03), readmission (6.9 versus 9.7%; P = 0.04), any medical complication (10.5 versus 14.1%; P = 0.03), and postoperative hematoma formation (0 versus 1.3%, P < 0.01) than controls. Patients who had morbid obesity on GLP-1 RA demonstrated lower rates of hematoma formation (0 versus 1.0%; P < 0.01) than patients who had severe obesity (BMI = 35.0 to 39.9). There were no differences in 2-year surgical complications.
Perioperative use of GLP-1 RA in patients who had morbid obesity is associated with reduced risk of acute periprosthetic joint infection and 90-day hospital readmission. The risk is reduced to a level comparable to obese patients who have a BMI < 40.0. Randomized controlled trials are necessary to determine the true effect and mechanism of action.
病态肥胖对全髋关节置换术（THA）后的疗效有负面影响。THA术前减肥的最佳策略尚未明确。近年来，胰高血糖素样肽-1受体激动剂（GLP-1 RAs）作为一种有效的药物减肥剂越来越受欢迎。本研究的目的是评估围手术期使用GLP-1 RAs对病态肥胖患者初次行THA术后疗效的影响。
利用行政索赔数据库，识别出病态肥胖（体重指数[BMI]≥40.0）且接受初次THA的患者。将术前及术后三个月使用GLP-1 RAs的病态肥胖患者（治疗组）与未使用GLP-1 RAs的病态肥胖患者（对照组）以及严重肥胖（BMI = 35.0至39.9）的患者进行1:4:4配比，治疗组、对照组和严重肥胖对照组分别有771例、3084例和3084例患者。采用单变量检验比较90天和2年术后疗效的总体组间差异，随后进行事后两两检验和P值调整。
使用GLP-1 RAs的病态肥胖患者90天假体周围关节感染率（1.6%对3.2%；P = 0.03）、再入院率（6.9%对9.7%；P = 0.04）、任何医疗并发症发生率（10.5%对14.1%；P = 0.03）和术后血肿形成率（0对1.3%，P < 0.01）均显著低于对照组。使用GLP-1 RAs的病态肥胖患者血肿形成率（0对1.0%；P < 0.01）低于严重肥胖（BMI = 35.0至39.9）患者。2年手术并发症无差异。
病态肥胖患者围手术期使用GLP-1 RAs可降低急性假体周围关节感染风险和90天再次入院风险。该风险降低至与BMI < 40.0的肥胖患者相当的水平。需要进行随机对照试验以确定其真正效果和作用机制。
