Daher Mohammad, Liu Jonathan, Smith Nathaniel, Daniels Alan, Barrett Thomas, Cohen Eric
Brown University, Providence, United States.
Eur J Orthop Surg Traumatol. 2025 May 11;35(1):185. doi: 10.1007/s00590-025-04325-1.
The prevalence of obesity and morbid obesity in the U.S. has reached record levels, with over 50% of adults affected. Obese patients undergoing total joint arthroplasty (TJA) face increased post-operative complications, yet studies on optimizing outcomes for this population are limited. The COVID-19 pandemic accelerated the shift towards same-day discharge (SDD) for TJA, but the impact on morbidly obese patients remains understudied. This study aims to fill this gap by examining outcomes and costs for morbidly obese patients undergoing SDD TJA.
This study is a retrospective review of the PearlDiver Mariner Database. Based on the procedure and their body mass index (BMI), the patients were divided into 4 SDD groups: Total knee arthroplasty (TKA)-BMI > 40, TKA-BMI < 40, total hip arthroplasty (THA)-BMI > 40, and THA-BMI < 40. The two TKA groups were matched based on age, gender, and the Charlson comorbidity index (CCI). The THA groups were matched similarly. Outcomes at 30 and 90 days post-operatively were compared between the groups.
5588 patients were included in each TKA group, and 1675 patients in each THA group. When compared to individuals with a BMI of less than 40, patients with morbid obesity receiving SDD TKA had greater incidence of deep vein thrombosis (DVT) (p < 0.05), urinary tract infection (UTI) (p < 0.05), readmissions (p < 0.05), superficial surgical site infection (SSSI) (p < 0.05), and higher costs (p < 0.05). Regarding SDD THA, patients with morbid obesity had greater incidence of DVT (p < 0.05), UTI (p < 0.05), emergency department visits (p < 0.05), readmissions (p < 0.05), intensive care unit admission (p < 0.05), prosthetic joint infection (p < 0.05), SSSI (p < 0.05), and higher costs (p < 0.05).
This study highlights the considerable challenges faced by morbidly obese patients undergoing SDD TJA. Patient optimization prior to undergoing total joint replacement may benefit morbidly obese patients undergoing same day discharge. Further research is needed.
美国肥胖和病态肥胖的患病率已达到创纪录水平，超过50%的成年人受到影响。接受全关节置换术（TJA）的肥胖患者术后并发症增加，但针对该人群优化治疗效果的研究有限。新冠疫情加速了TJA向当日出院（SDD）的转变，但对病态肥胖患者的影响仍未得到充分研究。本研究旨在通过检查接受SDD TJA的病态肥胖患者的治疗效果和成本来填补这一空白。
本研究是对PearlDiver Mariner数据库的回顾性分析。根据手术方式和体重指数（BMI），将患者分为4个SDD组：全膝关节置换术（TKA）-BMI>40、TKA-BMI<40、全髋关节置换术（THA）-BMI>40和THA-BMI<40。两个TKA组根据年龄、性别和Charlson合并症指数（CCI）进行匹配。THA组也进行了类似的匹配。比较各组术后30天和90天的治疗效果。
每个TKA组纳入5588例患者，每个THA组纳入1675例患者。与BMI小于40的个体相比，接受SDD TKA的病态肥胖患者深静脉血栓形成（DVT）发生率更高（p<0.05）、尿路感染（UTI）发生率更高（p<0.05）、再入院率更高（p<0.05）、手术部位浅表感染（SSSI）发生率更高（p<0.05），且成本更高（p<0.05）。关于SDD THA，病态肥胖患者DVT发生率更高（p<0.05）、UTI发生率更高（p<0.05）、急诊就诊率更高（p<0.05）、再入院率更高（p<0.05）、重症监护病房入住率更高（p<0.05）、人工关节感染发生率更高（p<0.05）、SSSI发生率更高（p<0.05），且成本更高（p<0.05）。
本研究突出了接受SDD TJA的病态肥胖患者面临的巨大挑战。在进行全关节置换术前对患者进行优化可能会使接受当日出院的病态肥胖患者受益。需要进一步研究。
