Abstract
Purpose
The presence of obesity poses a challenge for clinical and administrative staff in the peri-operative setting. Evidence indicates that obesity may increase peri-operative complications. However, data on resource utilization in patients undergoing total knee and hip arthroplasty remain rare. Using national data, we sought to determine whether increasing levels of patient obesity is associated with greater resource utilization. We hypothesized that patient care in individuals with a body mass index (BMI) greater than 40 is associated with longer operative and anaesthetic times, longer hospital stays, and greater readmission rates.
Methods
We utilized national data from the National Surgical Quality Improvement Project and identified patients who underwent primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Patients were divided into three groups according to their BMI (18.5 BMI < 30, 40 BMI < 45, and 45 BMI). The groups were compared regarding associated operating room utilization, length of stay, and readmission rates.
Results
Our study showed that TKA and THA patients with higher BMI required significantly longer operation-related times and had higher total length of hospital stay. Higher BMI patients also carried higher odds of readmissions within 30 days in both TKA and THA groups.
Conclusion
We conclude that BMI status needs to be considered for both medical and economic reasons by health care institutions and payers, in order to make prudent decisions in a world where health care expenses are rising rapidly alongside the increasing obesity epidemic, and resources are becoming increasingly scarce.
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References
Changulani M, Kalairajah Y, Peel T, Field RE (2008) The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br 90(3):360–363. https://doi.org/10.1302/0301-620X.90B3.19782
Flugsrud GB, Nordsletten L, Espehaug B, Havelin LI, Engeland A, Meyer HE (2006) The impact of body mass index on later total hip arthroplasty for primary osteoarthritis: a cohort study in 1.2 million persons. Arthritis Rheum 54(3):802–807. https://doi.org/10.1002/art.21659
Raphael IJ, Parmar M, Mehrganpour N, Sharkey PF, Parvizi J (2013) Obesity and operative time in primary total joint arthroplasty. J Knee Surg 26(2):95–99. https://doi.org/10.1055/s-0033-1333663
Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D (2012) The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 94(20):1839–1844. https://doi.org/10.2106/JBJS.K.00820
Namba RS, Paxton L, Fithian DC, Stone ML (2005) Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplast 20(7 Suppl 3):46–50. https://doi.org/10.1016/j.arth.2005.04.023
Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE (2009) Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplast 24(6 Suppl):84–88. https://doi.org/10.1016/j.arth.2009.05.016
Ma Z, Guo F, Qi J, Xiang W, Zhang J (2016) Meta-analysis shows that obesity may be a significant risk factor for prosthetic joint infections. Int Orthop 40(4):659–667. https://doi.org/10.1007/s00264-015-2914-4
Minarro JC, Urbano-Luque MT, Quevedo-Reinoso R, Lopez-Pulido MJ, Fernandez-Gonzalez A, Delgado-Martinez AD (2016) Is obesity related with periprosthetic fractures around the knee? Int Orthop 40(8):1583–1586. https://doi.org/10.1007/s00264-015-3071-5
Gaillard R, Cerciello S, Lustig S, Servien E, Neyret P (2017) Risk factors for tibial implant malpositioning in total knee arthrosplasty-consecutive series of one thousand, four hundred and seventeen cases. Int Orthop 41(4):749–756. https://doi.org/10.1007/s00264-016-3307-z
Triantafyllopoulos GK, Poultsides LA, Sakellariou VI, Zhang W, Sculco PK, Ma Y, Sculco TP (2015) Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome. Int Orthop 39(6):1203–1209. https://doi.org/10.1007/s00264-015-2753-3
Schoch BS, Aibinder WR, Werthel JD, Sperling JW, Sanchez-Sotelo J, Cofield RH (2017) Shoulder arthroplasty following gastric bypass, do complications follow? Int Orthop 42(2):345–349. https://doi.org/10.1007/s00264-017-3579-y
Yeung E, Jackson M, Sexton S, Walter W, Zicat B, Walter W (2011) The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop 35(6):929–934. https://doi.org/10.1007/s00264-010-1051-3
Adhikary SD, Liu WM, Memtsoudis SG, Davis CM 3rd, Liu J (2016) Body mass index more than 45 kg/m(2) as a cutoff point is associated with dramatically increased postoperative complications in total knee arthroplasty and total hip arthroplasty. J Arthroplast 31(4):749–753. https://doi.org/10.1016/j.arth.2015.10.042
Jarvenpaa J, Kettunen J, Soininvaara T, Miettinen H, Kroger H (2012) Obesity has a negative impact on clinical outcome after total knee arthroplasty. Scand J Surg 101(3):198–203. https://doi.org/10.1177/145749691210100310
Burwell SM (2015) Setting value-based payment goals—HHS efforts to improve U.S. health care. New Engl J Med 372(10):897–899. https://doi.org/10.1056/NEJMp1500445
D’Apuzzo MR, Novicoff WM, Browne JA (2015) The John Insall Award: morbid obesity independently impacts complications, mortality, and resource use after TKA. Clin Orthop Relat Res 473(1):57–63. https://doi.org/10.1007/s11999-014-3668-9
Kim SH (2010) Morbid obesity and excessive hospital resource consumption for unilateral primary hip and knee arthroplasty. J Arthroplast 25(8):1258–1266. https://doi.org/10.1016/j.arth.2009.09.005
Batsis JA, Naessens JM, Keegan MT, Huddleston PM, Wagie AE, Huddleston JM (2010) Body mass index and the impact on hospital resource use in patients undergoing total knee arthroplasty. J Arthroplast 25(8):1250–1257 e1251. https://doi.org/10.1016/j.arth.2009.09.009
Batsis JA, Naessens JM, Keegan MT, Wagie AE, Huddleston PM, Huddleston JM (2009) Impact of body mass on hospital resource use in total hip arthroplasty. Public Health Nutr 12(8):1122–1132. https://doi.org/10.1017/S1368980009005072
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Girardi, F.M., Liu, J., Guo, Z. et al. The impact of obesity on resource utilization among patients undergoing total joint arthroplasty. International Orthopaedics (SICOT) 43, 269–274 (2019). https://doi.org/10.1007/s00264-018-4059-8
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DOI: https://doi.org/10.1007/s00264-018-4059-8