Bariatric surgery prior to total hip arthroplasty: does timing or type matter?

Autor:	Bains, Sandeep S, Sax, Oliver C, Chen, Zhongming, Nabet, Austin, Nace, James, Delanois, Ronald E
Předmět:	INFECTION risk factors STATISTICS TOTAL hip replacement SURGICAL anastomosis BARIATRIC surgery HIP joint MULTIVARIATE analysis TIME SURGICAL complications MORBID obesity ARTIFICIAL joints HIP joint dislocation RISK assessment GASTRECTOMY REOPERATION CHI-squared test SMALL intestine BODY mass index LOGISTIC regression analysis GASTRIC bypass COMPLICATIONS of prosthesis DISEASE risk factors
Zdroj:	Hip International; Nov2023, Vol. 33 Issue 6, p1017-1025, 9p
Abstrakt:	Introduction: Morbid obesity is a known risk-factor for increased complications following total hip arthroplasty (THA). Thus, many orthopaedic surgeons recommend bariatric surgery (BS). However, there is no consensus on the type (commonly either a Roux-en-Y gastric bypass [RYGB] or sleeve gastrectomy [SG]) and timing of BS prior to THA. Therefore, the purpose of this study is to compare BS recipients prior to THA to assess differences in 90-day to 2-year medical/surgical complications as well as revisions for: (1) type of BS (RYGB and SG); and (2) timing of BS. Additionally, we aim to assess risk factors for postoperative prosthetic joint infections (PJIs), dislocations, and revisions. Methods: We queried a national, all-payer database to identify patients undergoing primary THA from January 2010 to October 2020 (n = 715,100). Patients were then divided into 6 cohorts: 2 cohorts without history of BS (body mass index [BMI] kg/m2 20–35 [ n = 59,995]) and BMI > 40 [ n = 36,799]); 2 cohorts with previous RYGB (n = 1278) or SG (n = 1051); and 2 cohorts that underwent BS either 6–12 months (n = 412) and >12 months (n = 1655) prior to the THA. Bivariate chi-square analyses of medical and surgical outcomes at 90 days–2 years were conducted. Multivariate logistic regressions identified independent risk factors for PJIs, dislocations, and revisions. Results: At 90 days–2 years, no differences in postoperative medical/surgical complications or revisions were seen among timing or type of BS. The BMI > 40 kg/m2 cohort had the highest complication profile among all other cohorts. Timing and type of BS has similar odds of PJIs, dislocations, and revisions. Conclusions: Patients undergoing RYGB or SG 6–12 months and >1 year prior to THA showed similar complications profiles. These results suggest, bariatric patients do not need to wait 1 year before undergoing a THA. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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