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Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 Danish patients undergoing hip or knee replacement

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@article{4015fe0a6f7e42fea0fef472fce820ae,
title = "Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 Danish patients undergoing hip or knee replacement",
abstract = "Background and purpose - Obesity is a risk factor for osteoarthritis in the lower limb, yet the cardiovascular risks associated with obesity in hip or knee replacement surgery are unknown. We examined associations between body mass index (BMI) and the risk of a major adverse cardiovascular event (MACE: ischemic stroke, acute myocardial infarction, or cardiovascular death) or the risk of all-cause mortality in a nationwide Danish cohort of patients who underwent primary hip or knee replacement surgery. Methods - Using Danish nationwide registries, we identified 34,744 patients aged ≥ 20 years who underwent elective primary hip or knee replacement surgery between 2005 and 2011. We used multivariable Cox regression models to calculate the 30-day risks of MACE and mortality associated with 5 BMI groups (underweight (BMI < 18.5 kg/m(2)), normal weight (18.5-24 kg/m(2)), overweight (25-29 kg/m(2)), obese 1 (30-34 kg/m(2)), and obese 2 (≥ 35 kg/m(2))). Results - In total, 232 patients (0.7{\%}) had a MACE and 111 (0.3{\%}) died. Compared with overweight, adjusted hazard ratios (HRs) were 1.2 (95{\%} CI: 0.4-3.3), 1.3 (0.95-1.8), 1.6 (1.1-2.2), and 1.0 (0.6-1.9) for underweight, normal weight, obese 1, and obese 2 regarding MACE. Regarding mortality, the corresponding HRs were 7.0 (2.8-15), 2.0 (1.2-3.2), 1.5 (0.9-2.7), and 1.9 (0.9-4.2). Cubic splines suggested a significant U-shaped relationship between BMI and risks with nadir around 27-28. Interpretation - In an unselected cohort of patients undergoing elective primary hip or knee replacement surgery, U-shaped risks of perioperative MACE and mortality were found in relation to BMI. Patients within the extreme ranges of BMI may warrant further attention.",
author = "Catharina Thornqvist and Gislason, {Gunnar H} and Lars K{\o}ber and Jensen, {Per F{\o}ge} and Christian Torp-Pedersen and Charlotte Andersson",
year = "2014",
month = "9",
doi = "10.3109/17453674.2014.934184",
language = "English",
volume = "85",
pages = "456--62",
journal = "Acta Orthopaedica (Print Edition)",
issn = "1745-3674",
publisher = "Taylor & Francis Ltd",
number = "5",

}

RIS

TY - JOUR

T1 - Body mass index and risk of perioperative cardiovascular adverse events and mortality in 34,744 Danish patients undergoing hip or knee replacement

AU - Thornqvist, Catharina

AU - Gislason, Gunnar H

AU - Køber, Lars

AU - Jensen, Per Føge

AU - Torp-Pedersen, Christian

AU - Andersson, Charlotte

PY - 2014/9

Y1 - 2014/9

N2 - Background and purpose - Obesity is a risk factor for osteoarthritis in the lower limb, yet the cardiovascular risks associated with obesity in hip or knee replacement surgery are unknown. We examined associations between body mass index (BMI) and the risk of a major adverse cardiovascular event (MACE: ischemic stroke, acute myocardial infarction, or cardiovascular death) or the risk of all-cause mortality in a nationwide Danish cohort of patients who underwent primary hip or knee replacement surgery. Methods - Using Danish nationwide registries, we identified 34,744 patients aged ≥ 20 years who underwent elective primary hip or knee replacement surgery between 2005 and 2011. We used multivariable Cox regression models to calculate the 30-day risks of MACE and mortality associated with 5 BMI groups (underweight (BMI < 18.5 kg/m(2)), normal weight (18.5-24 kg/m(2)), overweight (25-29 kg/m(2)), obese 1 (30-34 kg/m(2)), and obese 2 (≥ 35 kg/m(2))). Results - In total, 232 patients (0.7%) had a MACE and 111 (0.3%) died. Compared with overweight, adjusted hazard ratios (HRs) were 1.2 (95% CI: 0.4-3.3), 1.3 (0.95-1.8), 1.6 (1.1-2.2), and 1.0 (0.6-1.9) for underweight, normal weight, obese 1, and obese 2 regarding MACE. Regarding mortality, the corresponding HRs were 7.0 (2.8-15), 2.0 (1.2-3.2), 1.5 (0.9-2.7), and 1.9 (0.9-4.2). Cubic splines suggested a significant U-shaped relationship between BMI and risks with nadir around 27-28. Interpretation - In an unselected cohort of patients undergoing elective primary hip or knee replacement surgery, U-shaped risks of perioperative MACE and mortality were found in relation to BMI. Patients within the extreme ranges of BMI may warrant further attention.

AB - Background and purpose - Obesity is a risk factor for osteoarthritis in the lower limb, yet the cardiovascular risks associated with obesity in hip or knee replacement surgery are unknown. We examined associations between body mass index (BMI) and the risk of a major adverse cardiovascular event (MACE: ischemic stroke, acute myocardial infarction, or cardiovascular death) or the risk of all-cause mortality in a nationwide Danish cohort of patients who underwent primary hip or knee replacement surgery. Methods - Using Danish nationwide registries, we identified 34,744 patients aged ≥ 20 years who underwent elective primary hip or knee replacement surgery between 2005 and 2011. We used multivariable Cox regression models to calculate the 30-day risks of MACE and mortality associated with 5 BMI groups (underweight (BMI < 18.5 kg/m(2)), normal weight (18.5-24 kg/m(2)), overweight (25-29 kg/m(2)), obese 1 (30-34 kg/m(2)), and obese 2 (≥ 35 kg/m(2))). Results - In total, 232 patients (0.7%) had a MACE and 111 (0.3%) died. Compared with overweight, adjusted hazard ratios (HRs) were 1.2 (95% CI: 0.4-3.3), 1.3 (0.95-1.8), 1.6 (1.1-2.2), and 1.0 (0.6-1.9) for underweight, normal weight, obese 1, and obese 2 regarding MACE. Regarding mortality, the corresponding HRs were 7.0 (2.8-15), 2.0 (1.2-3.2), 1.5 (0.9-2.7), and 1.9 (0.9-4.2). Cubic splines suggested a significant U-shaped relationship between BMI and risks with nadir around 27-28. Interpretation - In an unselected cohort of patients undergoing elective primary hip or knee replacement surgery, U-shaped risks of perioperative MACE and mortality were found in relation to BMI. Patients within the extreme ranges of BMI may warrant further attention.

U2 - 10.3109/17453674.2014.934184

DO - 10.3109/17453674.2014.934184

M3 - Journal article

VL - 85

SP - 456

EP - 462

JO - Acta Orthopaedica (Print Edition)

JF - Acta Orthopaedica (Print Edition)

SN - 1745-3674

IS - 5

ER -

ID: 44677669