重度の肥満患者の膝関節整形手術後の血栓塞栓リスク:日本の医療主張データを用いた大規模な分析
Yu Mori1, Kunio Tarasawa2, Hidetatsu Tanaka1
1Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-Ku, Sendai, Miyagi 980-8574, Japan.
まとめ
日本人の重度の肥満は,膝関節整形手術後の静脈血栓塞栓症 (VTE) のリスクを高めます. 双方の手術が同時に行われる場合も VTE の危険性が高くなり,肥満患者には慎重に手術前治療が必要になります.
科学分野:
- 整形 術
- 血管 外科
- 肥満 医学
背景:
- 肥満は膝関節整形手術後の合併症の 既知の危険因子です
- 膝関節整形手術を受けた日本の患者における重度の肥満 (BMI ≥35 kg/ m2) の特異的な影響は,まだ十分に研究されていない.
研究 の 目的:
- 日本人の集団における全膝関節整形 (TKA) と単部膝関節整形 (UKA) の後の重度の肥満と術後の合併症との関連を調べる.
- この患者群で静脈血栓塞栓症 (VTE) の危険因子を特定する.
主な方法:
- 日本の診断手順コンビネーション (DPC) データベースを使用した遡及コホート研究 (2016年4月 - 2023年3月).
- 重度の肥満 (BMI ≥35 kg/ m2) と重度の肥満でない (BMI < 35 kg/ m2) のグループに分類された,TKAまたはUKAを受けた患者の含有.
- 1: 1の傾向スコアが共変数に匹敵し,その後,チ2テストとロジスティック回帰を用いた術後の合併症の比較分析が行われました.
主要な成果:
- 7832匹のマッチングペアの分析により,重度の肥満グループでは,深い静脈血栓症 (OR1.16) と肺栓塞 (OR1. 79) の発生率が著しく高かったことが明らかになった.
- 双方の手術を同時に行うことは,VTEの独立した危険因子として特定されました.
- 手術部位の感染,入院期間,または輸血量において,グループ間の有意な差異は認められなかった.
結論:
- 日本人の患者の膝関節整形手術後の重度の肥満は,静脈動脈炎の独立した危険因子です.
- この集団では同時に両側を手術するのもVTEの重要な危険因子です.
- 膝関節整形手術を受ける重度の肥満患者のために,調整された手術前管理戦略の重要性を強調しています.
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