Introduction:

Although differential outcomes based on sex are widespread in medicine and surgery, evaluation of sex-specific differences in the field of orthopaedic surgery in general – and arthroplasty in particular – are lacking. We hypothesised that morbidly obese male and female patients would have differing risks of surgical complications following primary total hip replacement.

Methods:

We reviewed data contained within the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from 2015 through 2018, inclusive. A multivariable binary logistic regression model was used to determine the adjusted odds ratios (OR) of relevant variables on primary and secondary outcomes.

Results:

A total of 86,684 patients undergoing THR were identified, of whom 9972 patients (4095 male and 5877 female) were morbidly obese. Among morbidly obese patients, odds of surgical site infection were higher in females than males within 30 days of surgery (adjusted OR 1.40; 95% CI, 1.10–1.79; p = 0.007). This comprised the odds of both superficial infection (1.8% vs. 1.1%, adjusted OR 1.67; 95% CI, 1.16–2.40; p = 0.006) and deep infection (1.9% vs. 1.4%, adjusted OR 1.22; 95% CI, 0.88–1.68; p = 0.24). Unexpected return to the operating room (i.e., reoperation) within 30 days of the surgical procedure was also higher among females than males (4.2% vs. 3.1%, adjusted OR 1.38, 95% CI, 1.10–1.71, p = 0.005). There were no differences between male and female patients in the non-obese cohort.

Conclusions:

Among patients with morbid obesity, the risk of surgical site infection and reoperation within the first 30 days is greater in women as compared to men. Future research must address whether this early increased risk among morbidly obese women persists in the longer term, and whether it results in compromised function or quality of life.

中文翻译：

---

86,684 名患者初次全髋关节置换术后 30 天结果的性别差异

介绍：

尽管基于性别的不同结果在医学和外科领域很普遍，但在骨科手术领域（尤其是关节置换术）中缺乏对性别特异性差异的评估。我们假设病态肥胖的男性和女性患者在初次全髋关节置换术后出现手术并发症的风险不同。

方法：

我们审查了 2015 年至 2018 年（含）美国外科医生学会国家质量改进计划 (ACS-NSQIP) 数据库中包含的数据。使用多变量二元逻辑回归模型来确定主要和次要结果相关变量的调整优势比（OR）。

结果：

总共确定了 86,684 名接受 THR 的患者，其中 9972 名患者（4095 名男性和 5877 名女性）患有病态肥胖。在病态肥胖患者中，手术后 30 天内，女性手术部位感染的几率高于男性（调整后 OR 1.40；95% CI，1.10–1.79；p  = 0.007）。这包括浅表感染（1.8% vs. 1.1%，调整后 OR 1.67；95% CI，1.16–2.40； p  = 0.006）和深层感染（1.9% vs. 1.4%，调整后 OR 1.22；95% CI）的几率。，0.88–1.68；p  = 0.24）。手术后 30 天内意外返回手术室（即再次手术）的女性也高于男性（4.2% vs. 3.1%，调整后 OR 1.38，95% CI，1.10–1.71，p = 0.005 ）  。在非肥胖队列中，男性和女性患者之间没有差异。

结论：

在病态肥胖患者中，女性在前 30 天内手术部位感染和再次手术的风险高于男性。未来的研究必须解决病态肥胖女性早期增加的风险是否会长期持续存在，以及是否会导致功能或生活质量受损。