The Obesity Paradox: Body Mass Index Complication Rates Vary by Gender and Age Among Primary Total Hip Arthroplasty Patients

2020 ◽  
Vol 35 (9) ◽  
pp. 2658-2665
Author(s):  
Eric L. Smith ◽  
Amir A. Shahien ◽  
Mei Chung ◽  
Geoffrey Stoker ◽  
Ruijia Niu ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Obesity Paradox ◽  
Complication Rates ◽  
Total Hip ◽  
Gender And Age ◽  
Primary Total Hip Arthroplasty

Extremes of body mass index have significant impact on complications, readmissions, and utilization of post-acute services after primary total hip arthroplasty

2020 ◽  
Vol 102-B (7_Supple_B) ◽  
pp. 62-70
Author(s):  
Geoffrey Tompkins ◽  
Chris Neighorn ◽  
Hsin-Fang Li ◽  
Kevin Fleming ◽  
Tom Lorish ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Operating Time ◽  
Inpatient Cost ◽  
Complication Rates ◽  
Total Hip ◽  
Increased Risk ◽  
Primary Total Hip Arthroplasty

Aims High body mass index (BMI) is associated with increased rates of complications in primary total hip arthroplasty (THA), but less is known about its impact on cost. The effects of low BMI on outcomes and cost are less understood. This study evaluated the relationship between BMI, inpatient costs, complications, readmissions, and utilization of post-acute services. Methods A retrospective database analysis of 40,913 primary THAs performed between January 2013 and December 2017 in 29 hospitals was conducted. Operating time, length of stay (LOS), complication rate, 30-day readmission rate, inpatient cost, and utilization of post-acute services were measured and compared in relation to patient BMI. Results Mean operating time increased with BMI and for BMI > 50 kg/m2 was approximately twice that of BMI 10 kg/m2 to 15 kg/m2. Mean inpatient cost did not vary significantly with BMI. Mean total reimbursement was lowest for the lowest BMI cohort and increased with BMI. Mean LOS was greatest at the extremes of BMI (4.0 days for BMI 10 kg/m2 to 15 kg/m2; 3.75 days for BMI > 50 kg/m2) and twice that of normal BMI. Mean complication rates were greatest in the lowest BMI cohort (16% for BMI 10 kg/m2 to 15 kg/m2) and five times the mean rate of complications in the normal BMI cohorts. Furthermore, 30-day readmissions were greatest in the highest BMI cohort (10% for BMI > 50 kg/m2) and five times the rate for normal BMI patients. Conclusion LOS, complications, and 30-day readmissions all increase at the extremes of BMI and appear to be greater than those of patients with normal BMI. The lowest BMI patients had the lowest payment for inpatient stay yet were at considerable risk for complications and readmission. Patients with extreme BMI should be counselled about their increased risk of complications for THA and nutritional status/obesity optimized preoperatively if possible. Cite this article: Bone Joint J 2020;102-B(7 Supple B):62–70.

scholarly journals Outcome in Patients with High Body Mass Index following Primary Total Hip Arthroplasty

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Zuned Hakim ◽  
Claire Rutherford ◽  
Elizabeth Mckiernan ◽  
Tony Helm
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Rank Correlation ◽  
High Body Mass Index ◽  
Total Hip ◽  
Significant Difference ◽  
Using Data ◽  
Primary Total Hip Arthroplasty

Obesity is becoming a critical problem in the developed world and is associated with an increased incidence of osteoarthritis of the hip. The Oxford Hip Score was used to determine if Body Mass Index (BMI) is an independent factor in determining patient outcome following primary total hip arthroplasty (THA). Using data from 353 operations we found that patients with BMI ≥ 30 had an absolute score that was lower preoperatively and postoperatively compared to those with a BMI < 30. There was no difference in pre- and postoperative point score change within each group; Kendall’s rank correlation was 0.00047 (95% CI, −0.073 to 0.074 (p=0.99)) and demonstrated no trend. There was no statistically significant difference in change between those with BMI ≥ 30 and < 30 (p=0.65). We suggest that those with a higher BMI be considered for THA as they can expect the same degree of improvement as those with a lower BMI. Given the on-going increase in obesity these findings could be significant for the future of THA.

Dislocation rate increases with bariatric surgery before total hip arthroplasty

2018 ◽  
Vol 28 (5) ◽  
pp. 559-565 ◽  
Author(s):  
Brian T Nickel ◽  
Mitchell R Klement ◽  
Colin Penrose ◽  
Cynthia L Green ◽  
Michael P Bolognesi ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Wound Complications ◽  
Complication Rates ◽  
Group Iii ◽  
Total Hip ◽  
Group I

Introduction: Annually in the USA, 113,000 patients with refractory obesity undergo bariatric surgery (BS), and a subset does so in order to lower body mass index to become a more desirable total hip arthroplasty (THA) candidate. This study aims to evaluate THA risk with and without bariatric surgery. Methods: 12,160 patients were identified in a claim-based review of the entire Medicare database with ICD-9 codes to identify patients in three groups. Patients who underwent BS prior to THA (Group I: 1,545 experimental group) and two control groups that did not undergo BS but had either a body mass index >40 (Group II: 6,918 bariatric control) or <25 (Group III: 3,697 normal weight control). Preoperative demographics/comorbidities and short-term medical (30 day) and long-term surgical (90-day and 2-year) complications were evaluated. Results: Group I had female predominance, youngest age, and highest incidence of: deficiency anaemia, cardiovascular disease, liver disease, diabetes, polysubstance abuse, psychiatric disorders and smoking. At 2 years, Group I had approximately twice the dislocation and revision risk compared to both Groups II and III; Groups I and II had over four times the risk of infection and wound complications compared to Group III. Conclusion: In the Medicare population, these patients continue to have complication rates similar to and sometimes greater than obese patients with no prior bariatric surgery. Greater dislocation risk is possibly due to ligamentous laxity related to decreased collagen/elastin and/or component malposition due to intraoperative visualisation challenges.

Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Hip Arthroplasty Patients of Varying Body Mass Index Levels

2019 ◽  
Vol 34 (3) ◽  
pp. 433-438 ◽  
Author(s):  
Karthikeyan E. Ponnusamy ◽  
Jacquelyn D. Marsh ◽  
Lyndsay E. Somerville ◽  
Richard W. McCalden ◽  
Edward M. Vasarhelyi
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Change in Body Mass Index in Patients Following Total Hip Arthroplasty.

2008 ◽  
Vol 21 (6) ◽  
pp. 1
Author(s):  
T. Bacon-Baguley ◽  
T. Mollan ◽  
P. Oleszkiewicz ◽  
D. Rispler
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Total Hip

scholarly journals Prediction of Functional Outcome at Six Months Following Total Hip Arthroplasty

2012 ◽  
Vol 92 (11) ◽  
pp. 1386-1394 ◽  
Author(s):  
Emily J. Slaven
Keyword(s):  
Body Mass Index ◽  
Logistic Regression ◽  
Total Hip Arthroplasty ◽  
Functional Outcome ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Walking Speed ◽  
Assistive Device ◽  
Total Hip ◽  
Cart Analysis

Background Recovery of function such as the ability to walk without an assistive device after total hip arthroplasty (THA) is not always automatic. Objective This study investigated whether predetermined variables could be used to identify patients who might have functional limitations at 6 months following THA. Design A prospective, observational cohort design was used. Method Demographics and baseline measures, including age, sex, and preoperative Lower Extremity Functional Scale (LEFS) score, were collected 1 to 3 weeks prior to surgery from 40 participants who were scheduled to undergo THA. Six weeks after surgery, a second LEFS score was recorded along with each participant's body mass index and the THA procedure performed; walking speed and balance also were assessed at this time using the 10-Meter Walk Test, the Timed “Up & Go” Test, and the Functional Reach Test. At 6 months following surgery, each participant's functional outcome was determined from the final LEFS score and the need for an assistive device. Classification and regression tree (CART) analyses and logistic regression were used to establish which of the variables could predict outcome at 6 months. Results Body mass index, sex, and age were identified by CART analysis as predictors to classify participants who did not reach successful outcome status. Logistic regression revealed that sex (female) was the only individual variable that predicted outcome at 6 months. Walking speed was the only performance variable identified as a predictor for outcome using CART analysis. Limitations Only a limited number of variables were observed due to the small sample size. Conclusion It is possible to identify those patients who are at risk for an unsuccessful outcome through the use of variables such as body mass index, age, and sex.

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