Aims To determine whether obesity and malnutrition have a synergistic effect on outcomes from skeletal trauma or elective orthopaedic surgery. Methods Electronic databases including MEDLINE, Global Health, Embase, Web of Science, ScienceDirect, and PEDRo were searched up to 14 April 2024, as well as conference proceedings and the reference lists of included studies. Studies were appraised using tools according to study design, including the Oxford Levels of Evidence, the Institute of Health Economics case series quality appraisal checklist, and the CLARITY checklist for cohort studies. Studies were eligible if they reported the effects of combined malnutrition and obesity on outcomes from skeletal trauma or elective orthopaedic surgery. Results A total of eight studies (106,319 patients) were included. These carried moderate to high risk of bias. Combined obesity and malnutrition did not lead to worse outcomes in patients undergoing total shoulder arthroplasty or repair of proximal humeral fractures (two retrospective cohort studies). Three studies (two retrospective cohort studies, one case series) found that malnourishment and obesity had a synergistic effect and led to poor outcomes in total hip or knee arthroplasty, including longer length of stay and higher complication rates. One retrospective cohort study pertaining to posterior lumbar fusion found that malnourished obese patients had higher odds of developing surgical site infection and sepsis, as well as higher odds of requiring a revision procedure. Conclusion Combined malnutrition and obesity have a synergistic effect and lead to poor outcomes in lower limb procedures. Appropriate preoperative optimization and postoperative care are required to improve outcomes in this group of patients.

中文翻译：

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营养不良和肥胖联合对创伤和骨科手术结果的影响。


目的 确定肥胖和营养不良是否对骨骼创伤或择期骨科手术的结局有协同作用。方法 检索截至 2024 年 4 月 14 日的电子数据库，包括 MEDLINE、Global Health、Embase、Web of Science、ScienceDirect 和 PEDRo，以及会议论文集和纳入研究的参考文献列表。根据研究设计使用工具对研究进行评估，包括牛津证据水平、卫生经济学研究所病例系列质量评估清单和队列研究的 CLARITY 清单。如果研究报告了营养不良和肥胖联合对骨骼创伤或择期骨科手术结局的影响，则研究符合纳入标准。结果 共纳入 8 项研究 （106,319 例患者）。这些研究具有中度至高度偏倚风险。肥胖和营养不良相结合并未导致接受全肩关节置换术或肱骨近端骨折修复的患者预后变差 （两项回顾性队列研究）。三项研究 （两项回顾性队列研究，一项病例系列） 发现营养不良和肥胖具有协同作用，导致全髋关节或膝关节置换术的不良结局，包括住院时间延长和并发症发生率较高。一项与后腰椎融合术有关的回顾性队列研究发现，营养不良的肥胖患者发生手术部位感染和脓毒症的几率更高，需要翻修手术的几率也更高。结论 营养不良和肥胖联合具有协同效应，并导致下肢手术的不良结局。需要适当的术前优化和术后护理来改善这组患者的预后。