Trends of Obese and Morbidly Obese Patients in Same-Day Bilateral Total Knee Arthroplasty from 2009 to 2016

AbstractAs obesity in the United States increases, the proportion of obese and morbidly obese patients undergoing same-day bilateral total knee arthroplasty (sd-BTKA) remains unknown. Therefore, this study analyzed: (1) incidence, (2) patient demographics, (3) patient course, and (4) patient outcomes in obese and morbidly obese patients undergoing sd-BTKA in the United States from 2009 to 2016. The National Inpatient Sample was queried for all sd-BTKA patients from 2009 to 2016, yielding 39,901 obese and 20,394 morbidly obese patients. Analyzed variables included overall incidence, age, length of stay (LOS), sex, race, payer, Charlson comorbidity index (CCI) status, disposition, complications, location/teaching status, region of hospital, costs, and charges. Categorical variables were evaluated with chi-square analysis, while continuous variables were analyzed by Student's t-tests. Overall, the number of sd-BTKAs decreased over the study period, although the proportion of both obese and morbidly obese patients increased (p < 0.001 for all). The most common CCI status, 3 + , decreased in proportion for both groups (p < 0.001 for all). Hospital costs decreased and charges increased for both groups (p < 0.001 for all). Mean LOS decreased and patients were most commonly discharged to skilled nursing facilities, although these proportions decreased (p < 0.001 for all). Respiratory failures (p < 0.001 for all) increased for both groups, while proportion of deep vein thromboses and hematomas/seromas (p < 0.001 for all) increased for obese patients and proportion of pulmonary emboli (p < 0.001) increased for morbidly obese patients. The results of this study appear to portray improving optimization and patient selection of higher body mass index (BMI) individuals undergoing this procedure. More information is needed comparing the safety of the sd-BTKA across patients of all BMI groups.

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The Rise of Obesity among Total Knee Arthroplasty Patients

The Journal of Knee Surgery ◽

10.1055/s-0040-1710566 ◽

2020 ◽

Author(s):

Nequesha S. Mohamed ◽

Wayne A. Wilkie ◽

Ethan A. Remily ◽

Iciar M. Dávila Castrodad ◽

Mirlande Jean-Pierre ◽

...

Keyword(s):

Morbid Obesity ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

The United States ◽

National Database ◽

Categorical Variables ◽

Morbidly Obese ◽

Obese Patients ◽

Total Knee ◽

Nonobese Patients

AbstractIn the United States, one-third of adults are considered obese, and demand for total knee arthroplasty (TKA) is expected to rise in these patients. Surgeons are reluctant to operate on obese patients, but it is important to understand how obesity has affected TKA utilization. This study utilizes a national database to evaluate incidence, demographics, outcomes, charges, and cost in nonobese, overweight, nonmorbidly obese, and morbidly obese TKA patients. We queried the National Inpatient Sample from 2009 to 2016 for primary TKA patients identifying 4,053,037 nonobese patients, 40,077 overweight patients, 809,649 nonmorbidly obese patients, and 428,647 morbidly obese patients. Chi-square was used to analyze categorical variables, and one-way analysis of variance was used to analyze continuous variables. Nonmorbidly obese and morbidly obese patients represented 23.2% of all TKAs. TKA utilization increased 4.1% for nonobese patients, 121.6% for overweight patients, 73.6% for nonmorbidly obese patients, and 83.9% for morbidly obese patients. Morbidly obese patients were younger (p < 0.001), female (p < 0.001), Black (p < 0.001), poor (p < 0.001), and utilized private insurance (p < 0.001). They also had the longest length of stay (p < 0.001) and the highest mortality rate (p < 0.001). More morbidly obese patients were discharged to other facilities (p < 0.001), and they had the highest rate of complications (p < 0.001). Patients with morbid obesity had the highest charges (p < 0.001), but overweight patients had the highest costs (p < 0.001). The results of this study demonstrate the rise in obese and morbidly obese patients seeking TKAs, which may be reflection of the obesity epidemic in America. Although TKA utilization has increased for morbidly obese patients, this body mass index (BMI) category also has the highest rates of charges and complications, suggesting morbid obesity to be a modifiable risk factor leading to worse surgical and economic outcomes. Obese patients undergoing TKA may benefit from preoperative optimization of their weight, in an effort to reduce the risk of adverse outcomes.

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Safety of Bilateral Total Knee Arthroplasty in Morbidly Obese Patients

Orthopedics ◽

10.3928/01477447-20140225-57 ◽

2014 ◽

Vol 37 (3) ◽

pp. e252-e259 ◽

Cited By ~ 14

Author(s):

Adam A. Madsen ◽

Benjamin C. Taylor ◽

Craig Dimitris ◽

Dane C. Hansen ◽

Robert A. Steensen ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Morbidly Obese ◽

Obese Patients ◽

Bilateral Total Knee Arthroplasty ◽

Total Knee

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Increased Prevalence, Complications, and Costs of Smokers Undergoing Total Knee Arthroplasty

The Journal of Knee Surgery ◽

10.1055/s-0040-1713128 ◽

2020 ◽

Author(s):

Sean S. Rajaee ◽

Eytan M. Debbi ◽

Guy D. Paiement ◽

Andrew I. Spitzer

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Smoking Status ◽

Hospital Costs ◽

Patient Characteristics ◽

The United States ◽

Bundled Payment ◽

Vein Thrombosis ◽

Total Knee ◽

Payment Models

AbstractGiven a national push toward bundled payment models, the purpose of this study was to examine the prevalence as well as the effect of smoking on early inpatient complications and cost following elective total knee arthroplasty (TKA) in the United States across multiple years. Using the nationwide inpatient sample, all primary elective TKA admissions were identified from 2012 to 2014. Patients were stratified by smoking status through a secondary diagnosis of “tobacco use disorder.” Patient characteristics as well as prevalence, costs, and incidence of complications were compared. There was a significant increase in the rate of smoking in TKA from 17.9% in 2012 to 19.2% in 2014 (p < 0.0001). The highest rate was seen in patients < 45 years of age (27.3%). Hospital resource usage was significantly higher for smokers, with a length of stay of 3.3 versus 2.9 days (p < 0.0001), and hospital costs of $16,752 versus $15,653 (p < 0.0001). A multivariable logistic model adjusting for age, gender, and comorbidities showed that smokers had an increased odds ratio for myocardial infarction (5.72), cardiac arrest (4.59), stroke (4.42), inpatient mortality (4.21), pneumonia (4.01), acute renal failure (2.95), deep vein thrombosis (2.74), urinary tract infection (2.43), transfusion (1.38) and sepsis (0.65) (all p < 0.0001). Smoking is common among patients undergoing elective TKA, and its prevalence continues to rise. Smoking is associated with higher hospital costs as well as higher rates of immediate inpatient complications. These findings are critical for risk stratification, improving of bundled payment models as well as patient education, and optimization prior to surgery to reduce costs and complications.

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