Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients
Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients
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DOI：
10.1007/s11999-013-3049-9
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发表时间：
2013-10-01
影响因子：
4.2
通讯作者：
Homering, Martin
中科院分区：
文献类型：
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作者：
Friedman, Richard J.;Hess, Susanne;Homering, Martin
病态肥胖已被证明是THA和TKA术后并发症增加的危险因素；然而，目前还缺乏确定效应大小的大型研究。本研究的目的是确定病态肥胖是否会增加以下风险：(1)静脉血栓栓塞（VTE），(2)出血，(3)其他不良事件，以及(4)THA或TKA术后早期（长达6至8周）感染的风险？回顾性分析利伐沙班预防全髋关节置换术或全髋关节置换术后静脉血栓形成（VTE）的骨科手术凝血预防深静脉血栓形成和肺栓塞（RECORD）临床试验项目的数据。对12355名患者的数据进行了回顾，以确定病态肥胖患者（BMI为千分之一日元40 kg/m(2)）与BMI低于40 kg/m(2)的患者的并发症发生率。探索性分析比较BMI组无症状深静脉血栓（DVT）、症状性DVT、症状性肺栓塞、出血及其他不良事件发生率。无症状性深静脉血栓、有症状性深静脉血栓、有症状性肺栓塞或出血方面无显著差异，但其他不良事件（包括输血、红斑、周围水肿、腹泻、胃肠道或腹痛）和感染（包括呼吸道或肺部感染、伤口炎症或感染、手术外部位感染）的发生率有所增加。BMI为40 kg/m(2)或更高的患者与BMI小于40 kg/m(2)的患者相比。THA或TKA术后，病态肥胖与静脉血栓栓塞或出血风险增加无关，但与术后早期并发症增加相关，包括红斑、外周水肿、腹泻、胃肠道或腹痛、伤口炎症或感染、手术外部位感染、呼吸道或肺部感染。III级，治疗性研究。有关证据水平的完整描述，请参见作者指南。
Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking.The purposes of this study were to determine whether morbid obesity increased the risk of: (1) venous thromboembolism (VTE), (2) bleeding, (3) other adverse events, and (4) infections during the early postoperative period (up to 6 to 8 weeks) after THA or TKA?Data from the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) clinical trial program of rivaroxaban for prevention of VTE after THA or TKA were analyzed retrospectively. Data for 12,355 patients were reviewed to identify complication rates in morbidly obese patients (BMI a parts per thousand yen 40 kg/m(2)) compared with patients with a BMI less than 40 kg/m(2). Explorative analyses compared the rates of asymptomatic deep vein thrombosis (DVT), symptomatic DVT, symptomatic pulmonary embolism, bleeding, and other adverse events by BMI group.There were no significant differences in asymptomatic DVT, symptomatic DVT, symptomatic pulmonary embolism, or bleeding, but there were increases in other adverse events (including receipt of blood transfusion, erythema, peripheral edema, diarrhea, gastrointestinal or abdominal pain) and infections (including respiratory tract or lung infections, wound inflammation or infection, and extrasurgical-site infections), in patients with a BMI of 40 kg/m(2) or greater compared with patients with a BMI less than 40 kg/m(2).After THA or TKA, morbid obesity is not associated with an increased risk of VTE or bleeding but is associated with increased early postoperative complications, including erythema, peripheral edema, diarrhea and gastrointestinal or abdominal pain, wound inflammation or infection, extrasurgical-site infections, and respiratory tract or lung infections.Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.