Bariatric Surgery and Time to Total Joint Arthroplasty: Does It Affect Readmission and Complication Rates?

Schwarzkopf, Ran; Hooper, Jessica; Parikh, Manish; Gold, Heather T.

doi:10.1007/s11695-017-3034-6

Cited by 42 publications

(24 citation statements)

References 27 publications

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“…Outcomes studied included early (in-hospital and 30-day) complications, 90-day complications, 1- or 2-year complications, mortality rates, revision rates, and LOS. Of the 13 studies included in this review, 5 (38%) analyzed both THA and TKA after BS [15, 17, 24, 28, 31], while 7 (54%) focused exclusively on TKA [19, 22, 29, 30, 36, 37, 43]. One paper (8%) focused solely on THA [42].…”

Section: Resultsmentioning

confidence: 99%

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The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

Cohen

Malahias

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background Obesity is an independent risk factor for osteoarthritis and has been associated with increased rate of complications following lower-extremity total joint arthroplasty (TJA). Bariatric surgery (BS) is a surgical option for weight loss and for reducing obesity-related comorbidities in morbidly obese patients. Purpose/Questions The goal of this systematic review was to answer the following questions: (1) Does BS prior to TJA correlate with lower post-operative complication rates in morbidly obese patients undergoing TJA? (2) Does BS have an impact on revision rates following TJA? Methods Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist, a systematic review of medical databases (PubMed/ MEDLINE, Cochrane Library, Web of Science, and Clinicaltrials.gov ) was undertaken for articles published in English from January 1990 to September 2018. Inclusion criteria were studies that included at least ten patients who underwent BS prior to TJA, collected data on complications or other outcomes, and followed patients for at least 90 days after TJA. A descriptive and critical analysis of the results was performed. Results From 799 studies, 13 met inclusion criteria. A total of 11,770 patients who had undergone bariatric surgery prior to TJA were analyzed. The quality of the evidence ranged between moderate and high. There was no consensus on the effect of previous BS on early- to short-term outcomes reported after TJA. Conclusion The literature remains conflicted on the impact of BS prior to TJA on early, short-term, and long-term complications after TJA. Additional well-matched, observational studies may further our understanding of the impact of BS prior to TJA on outcomes. In particular the effect of various types of BS prior to TJA on outcomes has yet to be elucidated. Ideally, prospective studies with higher level of evidence will be more definitive on the effects of BS prior to TJA. Prospero Registration Number: CRD42016043025. Electronic supplementary material The online version of this article (10.1007/s11420-019-09674-2) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…The average MINORS score was 17.6 (73.3%; range 8 to 21). Among the selected studies, three (23.1%) denote reduction in BMI between BS and TJA [22, 31, 42], while 10 (76.9%) did not mention changes in BMI [15, 17, 19, 20, 24, 28, 29, 36, 37, 43].…”

Section: Resultsmentioning

confidence: 99%

The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

Cohen

Malahias

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…We set the cut-off time between BS and TKA as within 2 years to minimize the risk of other confounding health factors affecting outcome. In addition, time to TKA after BS has been suggested to be between 6 months and 2 years (Schwarzkopf et al 2018).…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients

et al. 2020

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“…Although limited, the data that address the temporal relationship between bariatric surgery and subsequent major surgery demonstrated poorer outcomes in patients who underwent major surgery within 6 months of bariatric surgery. Schwarzkopf et al [ 10 ] reviewed the California State Inpatient Database for all patients who underwent bariatric surgery followed by total joint arthroplasty (TJA) and noted a significant increase in readmission within 90 days in patients who had arthroplasty performed within 6 months from bariatric surgery [ 10 ]. Given this information, we suggest that spinal surgery should be scheduled at least 6 months after massive weight loss.…”

Section: Discussionmentioning

confidence: 99%

Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

et al. 2020

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To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS). Overview of Literature: Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese. Methods: Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t-tests were used to compare the outcomes. Results: Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p<0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, p<0.05), increased number of blood transfusions (40.0 vs. 20.0, p<0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, p<0.05). Conclusions: On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions.

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Bariatric Surgery and Time to Total Joint Arthroplasty: Does It Affect Readmission and Complication Rates?

Cited by 42 publications

References 27 publications

The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

The Effect of Bariatric Surgery Prior to Lower-Extremity Total Joint Arthroplasty: A Systematic Review

Bariatric surgery prior to total knee arthroplasty is not associated with lower risk of revision: a register-based study of 441 patients

Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

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