Aims The purpose of this study was to determine the association between prior sleeve gastrectomy in patients undergoing primary total hip and knee arthroplasty, and 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. Methods This is a retrospective, single-centre analysis. Patients undergoing primary hip or knee arthroplasty with a prior sleeve gastrectomy were eligible for inclusion (n = 80 patients). A morbidly obese control group was established from the same institutional registry using a 1:2 match, for cases:controls with arthroplasty based on propensity score using age, sex, pre-sleeve gastrectomy BMI, Current Procedural Terminology code to identify anatomical location, and presurgical haemoglobin A1C. Outcomes included 90-day complications, incidence of revision arthroplasty, and patient-reported outcome scores at final follow-up. Multivariable logistic regressions evaluated associations of underlying preoperative demographic and treatment characteristics with outcomes. Results Complications within 90 days of surgery were increased in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (odds ratio (OR) 4.00 (95% CI 1.14 to 13.9); p = 0.030). Postoperative revisions were similar in the sleeve gastrectomy group relative to the obese control group after controlling for underlying preoperative demographic characteristics (OR 17.8 (95% CI 0.64 to 494.3); p = 0.090). Patient-Reported Outcomes Measurement Information System (PROMIS) depression decreased by a greater amount from pre- to postoperative in the obese controls relative to the sleeve gastrectomy group (OR 4.04 (95% CI 0.06 to 8.02); p = 0.047). PROMIS pain interference and physical function change from pre- to postoperative was not associated with sleeve gastrectomy status. Conclusion We found a higher rate of complications at 90 days in patients who underwent sleeve gastrectomy prior to primary hip or knee arthroplasty relative to a matched, obese control population. Prosthetic revision rates were similar between the two groups, while improvements in PROMIS depression scores were larger in the obese cohort. This study suggests that sleeve gastrectomy to achieve preoperative weight loss prior to arthroplasty surgery may not mitigate early complication risks in obese patient populations.

中文翻译：

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初次全髋关节和全膝关节置换术前的袖状胃切除术与早期并发症的风险增加有关。


目的 本研究的目的是确定接受初次全髋关节和膝关节置换术的患者既往袖状胃切除术与 90 天并发症、翻修关节置换术的发生率和最终随访时患者报告的结果评分之间的关联。方法 这是一项回顾性、单中心分析。接受初次髋关节或膝关节置换术并既往袖状胃切除术的患者符合纳入条件 （n = 80 名患者）。使用 1：2 匹配从同一机构登记处建立病态肥胖对照组，对于病例：根据倾向评分使用年龄、性别、袖状胃切除术前 BMI、当前程序术语代码确定解剖位置和术前血红蛋白 A1C 进行关节置换术的对照。结局包括 90 天并发症、翻修关节置换术的发生率和最终随访时患者报告的结局评分。多变量 logistic 回归评估了潜在的术前人口统计学和治疗特征与结局的关联。结果 在控制了潜在的术前人口学特征 （比值比 （OR） 4.00 （95% CI 1.14 - 13.9）;p = 0.030） 后，袖状胃切除术组术后 90 天内的并发症相对于肥胖对照组增加。在控制了潜在的术前人口学特征后，袖状胃切除术组与肥胖对照组的术后翻修相似 （OR 17.8 （95% CI 0.64 至 494.3;p = 0.090）。相对于袖状胃切除术组，肥胖对照组患者报告结局测量信息系统 （PROMIS） 抑郁从术前到术后下降的幅度更大 （OR 4.04 （95% CI 0.06 至 8.02）;p = 0.047）。 PROMIS 疼痛干扰和术前至术后的身体功能变化与袖状胃切除术状态无关。结论 我们发现，相对于匹配的肥胖对照人群，在初次髋关节或膝关节置换术前接受袖状胃切除术的患者在 90 天时的并发症发生率更高。两组之间的修复率相似，而肥胖队列中 PROMIS 抑郁评分的改善更大。这项研究表明，在关节置换术手术前通过袖状胃切除术实现术前体重减轻可能无法减轻肥胖患者群体的早期并发症风险。