Simpson Evan R, Hudson Parke, Deshpande Viraj, Guerrero Sean, Barnett Steven, Siljander Matthew P
Hoag Orthopedics, Irvine, CA.
Hoag Orthopedic Institute, Irvine, CA.
Arthroplast Today. 2025 Apr 4;33:101679. doi: 10.1016/j.artd.2025.101679. eCollection 2025 Jun.
Multiple studies have examined the relationship between obesity and increased risk of perioperative complications in patients undergoing total hip arthroplasty (THA). The purpose of this study was to compare the rate of perioperative complications stratified by body mass index (BMI) in patients undergoing THA through a direct anterior (DA) approach.
A retrospective review at a single high-volume orthopaedic specialty hospital identified all DA THAs performed between January 2019 and August 2022. Patients were stratified by BMI into the following cohorts: underweight (BMI<18.5), normal (BMI = 18.5-25), overweight (BMI = 25-30), obese class I (BMI = 30-35), obese class II (BMI = 35-39.9), and obese class III (BMI ≥ 40). Primary outcomes collected included 30-day and 90-day readmissions, emergency department visits, intraoperative fracture, and 90-day infection requiring return to the operating room. There were 4767 patients with a mean BMI of 28 kg/m (15.5-54.5) and a mean age of 67 years (18-100 years).
Thirty-day readmission rates in the obese class III (6.2%) were significantly higher when compared individually to all other cohorts ( < .001). Additionally, logistic regression found that underweight patients had an increased likelihood of an intraoperative fracture (odds ratio [OR]: 13.120, 95% confidence interval [CI]: 1.172-146.930, < .001), and both obese classes I and III were more likely to have a 90-day infection that required a return to the operating room (OR: 8.508, 95% CI: 1.023-70.779, < .001 and OR: 29.853, 95% CI: 2.683-332.187, < .001, respectively).
Obese class III patients have a higher rate of 30-day readmission following DA THA than all other BMI cohorts and are at increased risk of infection requiring return to the operating room when compared to patients with normal BMI. Surgeons should counsel patients regarding the increased potential complication risks related to BMI.
多项研究探讨了全髋关节置换术（THA）患者肥胖与围手术期并发症风险增加之间的关系。本研究的目的是比较采用直接前路（DA）入路进行THA的患者按体重指数（BMI）分层的围手术期并发症发生率。
在一家大型骨科专科医院进行回顾性研究，确定2019年1月至2022年8月期间所有采用DA入路的THA手术。患者按BMI分层为以下队列：体重过轻（BMI<18.5）、正常（BMI = 18.5-25）、超重（BMI = 25-30）、I级肥胖（BMI = 30-35）、II级肥胖（BMI = 35-39.9）和III级肥胖（BMI≥40）。收集的主要结局包括30天和90天再入院、急诊就诊、术中骨折以及需要返回手术室的90天感染。共有4767例患者，平均BMI为28kg/m²（15.5-54.5），平均年龄为67岁（18-100岁）。
III级肥胖患者的30天再入院率（6.2%）与所有其他队列相比显著更高（P<.001）。此外，逻辑回归发现体重过轻的患者术中骨折的可能性增加（比值比[OR]：13.120，95%置信区间[CI]：1.172-146.930，P<.001），I级和III级肥胖患者发生需要返回手术室的90天感染的可能性更大（OR：8.508，95%CI：1.023-70.779，P<.001；OR：29.853，95%CI：2.683-332.187，P<.001）。
DA入路THA术后，III级肥胖患者的30天再入院率高于所有其他BMI队列，与正常BMI患者相比，其需要返回手术室的感染风险增加。外科医生应就BMI相关的潜在并发症风险增加向患者提供咨询。
