Abstract：
In 2013, the American Association of Hip and Knee Surgeons tasked a workgroup to provide obesity-related recommendations in total joint arthroplasty and determined that patients who had body mass index (BMI) ≥ 40 seeking hip/knee arthroplasty were at increased perioperative risk and recommended preoperative weight reduction. Few studies have shown the actual results of instituting this; therefore, we reported the effect of instituting a BMI < 40 threshold in 2014 on our elective, primary total knee arthroplasties (TKAs).
We queried an institutional database to select all TKAs conducted from January 2010 to May 2020. There were 2,514 TKA pre-2014 and 5,545 TKA post-2014 that were identified. The 90-day emergency department (ED) visits, readmissions, and returns-to-operating room (OR) outcomes were identified. Patients were propensity score weight-matched as per comorbidities, age, initial surgical consultation (consult) BMI, and sex. We conducted 3 outcome comparisons: (1) pre-2014 patients who had a consult and surgical BMI ≥ 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40; (2) pre-2014 patients against post-2014 patients who had a consult and surgical BMI < 40; (3) post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40.
Pre-2014 patients who had a consult and surgical BMI ≥ 40 had more ED visits (12.5% versus 6%, P = .002) but similar readmissions and returns-to-OR than post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40. Pre-2014 patients who had a consult and surgical BMI < 40 had more readmissions (8.8% versus 6%, P < .0001) but similar ED visits and returns-to-OR when compared to their post-2014 counterparts. Post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 had fewer ED visits (5.8% versus 10.6%) but similar readmissions and returns-to-OR than patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40.
Patient optimization prior to total joint arthroplasty is essential. Enacting BMI reduction pathways prior to total knee arthroplasty seems to afford morbidly obese patients major risk mitigation. We must continue to ethically balance the pathology, expected improvement after surgery, and the overall risks of complications for each patient.
III.
We queried an institutional database to select all TKAs conducted from January 2010 to May 2020. There were 2,514 TKA pre-2014 and 5,545 TKA post-2014 that were identified. The 90-day emergency department (ED) visits, readmissions, and returns-to-operating room (OR) outcomes were identified. Patients were propensity score weight-matched as per comorbidities, age, initial surgical consultation (consult) BMI, and sex. We conducted 3 outcome comparisons: (1) pre-2014 patients who had a consult and surgical BMI ≥ 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40; (2) pre-2014 patients against post-2014 patients who had a consult and surgical BMI < 40; (3) post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 against post-2014 patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40.
Pre-2014 patients who had a consult and surgical BMI ≥ 40 had more ED visits (12.5% versus 6%, P = .002) but similar readmissions and returns-to-OR than post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40. Pre-2014 patients who had a consult and surgical BMI < 40 had more readmissions (8.8% versus 6%, P < .0001) but similar ED visits and returns-to-OR when compared to their post-2014 counterparts. Post-2014 patients who had a consult BMI ≥ 40 and surgical BMI < 40 had fewer ED visits (5.8% versus 10.6%) but similar readmissions and returns-to-OR than patients who had a consult BMI ≥ 40 and surgical BMI ≥ 40.
Patient optimization prior to total joint arthroplasty is essential. Enacting BMI reduction pathways prior to total knee arthroplasty seems to afford morbidly obese patients major risk mitigation. We must continue to ethically balance the pathology, expected improvement after surgery, and the overall risks of complications for each patient.
III.
摘要：
背景：2013年，美国髋关节和膝关节外科医生协会（AAHKS）委托一个工作组在全关节置换术中提供与肥胖相关的建议，并确定体重指数（BMI）≥40的患者寻求髋/膝关节置换术的围手术期风险增加，并建议术前减轻体重。很少有研究表明建立这种方法的实际结果，因此,我们报告了在2014年建立BMI<40阈值对我们选修的影响，原发性全膝关节置换术（TKA）。
方法：我们查询了一个机构数据库，以选择2010年1月至2020年5月进行的所有TKA。确定了2014年前的2,514个TKA和2014年后的5,545个TKA。90天急诊科（ED）就诊，再入院,并确定返回手术室(OR)结果。患者根据合并症进行倾向评分体重匹配，年龄,初次手术咨询（咨询）BMI，和性爱。我们进行了三个结果比较：A）2014年前咨询和手术BMI≥40的患者与2014年后咨询BMI≥40和手术BMI<40的患者；B）2014年前咨询和手术BMI<40的患者与2014年后咨询BMI≥40的患者；C）2014年后咨询BMI≥40和手术BMI<40的患者与2014年后咨询BMI≥40和手术BMI≥40的患者。
结果：在2014年之前，有咨询且手术BMI≥40的患者有更多的ED就诊（12.5对6％，p=0.002),但与2014年后咨询BMI≥40且手术BMI<40的患者相比,再次入院和恢复OR相似.在2014年之前，有咨询和手术BMI<40的患者有更多的再入院（8.8对6%，p<0.0001),但与2014年后的同行相比，ED访问和返回OR相似。2014年后，咨询BMI≥40且手术BMI<40的患者的ED就诊次数较少（5.8对10.6％），但与咨询BMI≥40和手术BMI≥40的患者相比,再入院和恢复OR相似.
结论：在进行全关节置换术前对患者进行优化是至关重要的。在全膝关节置换术之前制定BMI降低途径似乎可以缓解病态肥胖患者的主要风险。我们必须继续在道德上平衡病理学，手术后的预期改善，以及每位患者并发症的总体风险。
方法：我们查询了一个机构数据库，以选择2010年1月至2020年5月进行的所有TKA。
结果：在2014年之前，有咨询且手术BMI≥40的患者有更多的ED就诊（12.5对6％，
结论：在进行全关节置换术前对患者进行优化是至关重要的。
