减肥手术患者在全肩关节置换术后的5年翻修风险与III级肥胖患者相当

Q4 Medicine

Seminars in Arthroplasty Pub Date : 2024-12-01 DOI:10.1053/j.sart.2024.05.005

Sanjay Kubsad BS , Arman Kishan MBBS , Jordan Holland MPH , Henry Maxwell Fox MD , Jacob D. Mikula MD , Sarah Y. Nelson MD, MS , Umasuthan Srikumaran MD, MPH, MBA

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引用次数: 0

摘要

背景：肥胖与骨科手术后并发症的高风险相关。减肥手术（BS）是一种有效的工具，通常用于降低身体质量指数。然而，BS对全肩关节置换术（TSA）并发症的影响仍未充分研究。本研究考察了有BS病史的患者与无BS病史的匹配队列相比，TSA后5年的修订风险。方法利用PearlDiver Mariner数据库，对2010年1月至2021年10月期间超过1.57亿美国患者进行回顾性队列分析。纳入标准确定接受初级TSA的患者，随访至少2年。采用倾向评分匹配法控制变量，将BS患者与匹配的对照组和匹配的无BS病史的III类肥胖对照组进行比较。分析了人口统计学、合并症和结局，包括5年累计修订发生率。结果BS组5年累积全因修正发生率为4.6%。虽然这代表着比一般人群更高的风险(风险比1.70；95%可信区间为1.21-2.39)，与III类肥胖对照组相比无显著差异。与一般人群相比，BS组继发于脱位/半脱位和肩袖撕裂的翻修风险更高。与III级肥胖组相比，只有肩袖撕裂导致的翻修风险较高。结论：与没有BS病史的队列相比，有BS病史的个体在接受TSA后的修订风险更高，与III类肥胖对照组相比，其修订风险相当。虽然肥胖是TSA术后并发症的重要危险因素，但BS可能不是术前风险优化的有效工具。

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Bariatric surgery patients have 5-year risk of revision following total shoulder arthroplasty comparable to that of class III obesity patients

Background

Obesity has been correlated with heightened risk of complications after orthopedic surgeries. Bariatric surgery (BS) is an effective tool commonly utilized for the reduction of body mass index. However, the impact of BS on complications in total shoulder arthroplasty (TSA) remains inadequately investigated. This study examines the 5-year risk of revision following TSA in patients with a history of BS compared to matched cohorts without history of BS.

Methods

Utilizing the PearlDiver Mariner database, a retrospective cohort analysis was conducted on over 157 million U.S. patients from January 2010 to October 2021. Inclusion criteria identified patients undergoing primary TSA with a minimum 2-year follow-up. Propensity-score matching was employed to control for covariates, comparing BS patients with a matched control and a matched class III obesity control without history of BS. Demographics, comorbidities, and outcomes, including 5-year cumulative incidence of revision were analyzed.

Results

The 5-year cumulative incidence of all-cause revision within the BS group was found to be 4.6%. While this represented a higher risk than that of the general population (hazard ratio 1.70; 95% confidence interval 1.21-2.39), there was no significant difference when compared to controls with class III obesity. The BS cohort had higher risk of revision secondary to dislocation/subluxation and rotator cuff tear than in the general population. When compared to the class III obesity cohort, only the risk of revision due to rotator cuff tear was found to be higher.

Conclusion

Individuals with a history of BS showed a higher risk of revision than a cohort without history of BS and an equivalent risk of revision compared to a cohort of class III obesity controls after undergoing TSA. Though obesity is an important risk factor for complications after TSA, BS might not be an effective tool for preoperative risk optimization.

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来源期刊

Seminars in Arthroplasty Medicine-Surgery

CiteScore

1.00

自引率

0.00%

发文量

104

期刊介绍： Each issue of Seminars in Arthroplasty provides a comprehensive, current overview of a single topic in arthroplasty. The journal addresses orthopedic surgeons, providing authoritative reviews with emphasis on new developments relevant to their practice.