Body mass index and in-hospital postoperative complications following primary total hip arthroplasty

2018 ◽  
Vol 28 (6) ◽  
pp. 613-621 ◽  
Author(s):  
Usha Gurunathan ◽  
Cameron Anderson ◽  
Kate E Berry ◽  
Sarah L Whitehouse ◽  
Ross W Crawford
Keyword(s):  
Body Mass Index ◽  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Operating Time ◽  
Normal Weight ◽  
Cardiac Complications ◽  
Lower Odds ◽  
Obese Class

Background: The influence of obesity measured in terms of body mass index (BMI) on the complication rates following total hip arthroplasty (THA) is a matter of debate. Methods: This retrospective study conducted at a tertiary referral centre at Brisbane, Australia, examines the association between BMI and in-hospital postoperative complications, length of operating time and duration of hospital stay in 964 patients, who underwent THA from 2006 to 2010. Results: Amongst patients undergoing primary THA, when compared to the normal weight patients, those with BMI between 25 kg/m2 and 29.9 kg/m2 (overweight) and those with BMI between 35 kg/m2 and 39.9 kg/m2 (obese class II) had lower odds of perioperative complications (odds ratio [OR]: 0.62 (95% confidence intervals [CI], 0.43–0.92, p = 0.016) and OR: 0.60 (95% CI, 0.36– 0.99, p = 0.047 respectively). Patients with BMI less than or equal to 40 kg/m2 were also associated with significantly lower odds of cardiac complications ( p = 0.02). With unadjusted regression analysis, it was noted that those with BMI ≥40 kg/m2 had the highest odds of developing infectious complications (OR 2.68, 95% CI, 1.08–6.65, p < 0.05). As the BMI increased, there was a statistically significant increase in length of operating time ( p < 0.001). Conclusion: There is a significant impact of BMI on the occurrence of perioperative complications following THA. Compared to normal weight category, the overweight and obese class II patients had a lower likelihood of developing overall, especially cardiac complications. Length of operating time increases along with an increase in BMI.

scholarly journals Higher body mass index is not a risk factor for in-hospital adverse outcomes following total knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880242 ◽  
Author(s):  
Usha Gurunathan ◽  
Aaron Pym ◽  
Cameron Anderson ◽  
Amanda Marshall ◽  
Sarah L Whitehouse ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Normal Weight ◽  
Cardiac Complications ◽  
Weight Category ◽  
Obese Class ◽  
Total Knee

Purpose: To investigate the association between body mass index (BMI) and perioperative complications until hospital discharge, following primary total knee arthroplasty (TKA). Methods: This retrospective study reviewed 1665 cases of elective primary unilateral TKA performed between 2006 and 2010, from a prospective secure electronic database. Types of complications, length of operating time, and duration of hospital stay were analyzed in both adjusted (for known confounders) and unadjusted analyses. A further matched analysis was also performed. Results: In terms of overall complications, there was no statistically significant difference between the BMI categories. When individual obesity category was considered, obese 2 had the lowest odds of developing complications, both with unadjusted (odds ratio (OR): 0.61, 95% confidence interval (CI) 0.41–0.91, p < 0.015) and adjusted regression analysis (OR: 0.65, 95% CI: 0.43–0.99, p = 0.044). Compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at 66% (OR: 0.34, 95% CI: 0.21–0.55) lower (unadjusted) odds of developing cardiac complications (overall p < 0.001). With the matched analysis, compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at a 60% (OR: 0.40, 95% CI: 0.23–0.68) lower (unadjusted) odds of developing cardiac complications (overall p = 0.004). Obese 3 patients had significantly higher operating time compared with other groups ( p < 0.001). Conclusion: This study did not find a significant association between BMI and increased overall in-hospital medical or surgical complications following primary TKA. Obesity significantly increased the length of operating time.

Direct superior approach for total hip arthroplasty

2021 ◽  
Vol 103-B (3) ◽  
pp. 500-506
Author(s):  
Hollie J. Leonard ◽  
Nicholas E. Ohly
Keyword(s):  
Postoperative Complications ◽  
Total Hip Arthroplasty ◽  
Hospital Stay ◽  
Hip Arthroplasty ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Leg Length ◽  
Matched Group ◽  
Length Discrepancy ◽  
Superior Approach

Aims The purpose of this study was to compare the clinical, radiological, and patient-reported outcome measures (PROMs) in the first 100 consecutive patients undergoing total hip arthroplasty (THA) via a direct superior approach (DSA) with a matched group of patients undergoing THA by the same surgeon, using a posterolateral approach (PLA). Methods This was a retrospective single surgeon study comparing the first 100 consecutive DSA THA patients with a matched group of patients using a standard PLA. Case notes were examined for patient demographics, length of hospital stay, operating time, intra- and postoperative complications, pain score, satisfaction score, and Oxford Hip Score (OHS). Leg length discrepancy and component positioning were measured from postoperative plain radiographs. Results The DSA patients had a shorter length of hospital stay (mean 2.09 days (SD 1.20) DSA vs 2.74 days (SD 1.17) PLA; p < 0.001) and shorter time to discharge from the inpatient physiotherapy teams (mean 1.44 days (SD 1.17) DSA vs 1.93 days (SD 0.96) PLA; p < 0.001). There were no differences in operating time (p = 0.505), pain levels up to postoperative day 1 (p = 0.106 to p =0.242), OHS (p = 0.594 to p = 0.815), satisfaction levels (p = 0.066 to p = 0.299), stem alignment (p = 0.240), acetabular component inclination (p < 0.001) and anteversion (p < 0.001), or leg length discrepancy (p = 0.134). Conclusion While the DSA appears safe and was not associated with a significant difference in PROMs, radiological findings, or intraoperative or postoperative complications, a randomized controlled trial with functional outcomes in the postoperative phase is needed to evaluate this surgical approach formally. Cite this article: Bone Joint J 2021;103-B(3):500–506.

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 The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

2021 ◽  
Vol 10 (23) ◽  
pp. 5600
Author(s):  
Francesca Cannata ◽  
Alice Laudisio ◽  
Luca Ambrosio ◽  
Gianluca Vadalà ◽  
Fabrizio Russo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Charlson Score ◽  
Surgical Time ◽  
Orthopaedic Practice ◽  
Total Hip

Overweight represents a major issue in contemporary orthopaedic practice. A higher body mass index (BMI) is associated with an increase of perioperative complications following several orthopaedic procedures, in particular total hip arthroplasty (THA). However, the influence of overweight on THA surgical time is controversial. In this study, we investigated the association between BMI and surgical time analyzing the role of patients’ comorbidities. We conducted a retrospective study on 748 patients undergoing THA at our institutions between 2017 and 2018. Information regarding medical diseases was investigated and the burden of comorbidity was quantified using the Charlson score (CCI). Surgical time and blood loss were also recorded. Median surgical time was 76.5 min. Patients with surgical time above the median had both a higher BMI (28.3 vs. 27.1 kg/m2; p = 0.002); and CCI (1 vs. 0; p = 0.016). According to linear regression, surgical time was associated with BMI in the unadjusted model (p < 0.0001), after adjusting for age and sex (p < 0.0001), and in the multivariable model (p = 0.005). Furthermore, BMI was associated with increased surgical time only in patients with a Charlson score above the median, but not in others. Obesity is associated with increased surgical time during THA, especially in pluricomorbid patients, with a higher risk of perioperative complications.

scholarly journals TOTAL HIP ARTHROPLASTY IN PATIENTS WITH INCREASED BODY MASS INDEX AND OBESITY

2018 ◽  
Vol 25 (2) ◽  
pp. 63-70
Author(s):  
S. A. Ardashev ◽  
I. F. Akhtyamov ◽  
I. Sh. Gil’mutdinov ◽  
M. A.D Al’-Lami
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Surgical Intervention ◽  
Perioperative Complications ◽  
Total Hip ◽  
Foreign Literature

The modern native and foreign literature data on the hip arthroplasty results in patients with overweight including the data on the choice of the material and method of surgical intervention, risk and rate of perioperative complications, rehabilitation results are analyzed.

scholarly journals Predictors for Unfavorable Early Outcomes in Elective Total Hip Arthroplasty: Does Extreme Body Mass Index Matter?

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Chun-Yu Hung ◽  
Chih-Hsiang Chang ◽  
Yu-Chih Lin ◽  
Shen-Hsun Lee ◽  
Szu-Yuan Chen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Operative Time ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Complication Rates ◽  
Cardiovascular Comorbidities

Background. Studies of previous cohorts have demonstrated a controversial association between extreme body mass index (BMI) and complication rates following total hip arthroplasty (THA). The purpose of this study was to compare 30-day perioperative complications in underweight (BMI <18.50 kg/m2), normal-weight (BMI 18.50–24.99 kg/m2), overweight (BMI 25.00–29.99 kg/m2), class I obesity (BMI 30.00–34.99 kg/m2), and morbidly obese (BMI ≥35.00 kg/m2) groups. Methods. We performed a cohort study including patients who underwent unilateral primary THA by a single surgeon between January 2010 and December 2015 at our institution. We assessed 30-day complications, operation time, operative blood loss, and length of hospital stay. Results. We identified 1565 primary THAs that were performed in patients with varying BMI levels. Compared with the normal-weight patients, the morbidly obese group had a higher 30-day complication rate (8.9% vs. 2.4%), longer operative time (79 minutes vs. 70 minutes), and more blood loss (376 mL vs. 302 mL). Underweight patients did not present any 30-day complications, and there were no differences among underweight and normal-weight patients regarding complication rates, operative time, or blood loss. The mean length of hospital stay was comparable among the different BMI groups. In the multivariate regression model, higher BMI was not associated with a higher risk of 30-day complications. Independent risk factors for 30-day complications were advanced age, prolonged operative time, and cardiovascular comorbidities. Conclusion. Although increased operative time, blood loss, and perioperative complications were seen in the morbidly obese patients, BMI alone was not an independent risk factor for a higher 30-day complication rate. Therefore, our data suggest clinicians should make elderly patients aware of increased 30-day complications before the procedure, particularly those with cardiovascular comorbidities. Withholding THA solely on the basis of BMI is not justified.

Sign in / Sign up

Export Citation Format

Share Document