Can Patient Selection Explain the Obesity Paradox in Orthopaedic Hip Surgery? An Analysis of the ACS-NSQIP Registry

Abstract

Level III, therapeutic study.

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

“…Age, comorbidities and increased ASA class are known risk factors for complications after hip fracture surgery 17 , 18 . Nutritional status, malnourishment, as well as obesity, may also have an effect in increasing risk for complications 19 . We did not use the Nottingham score, and there is without doubt several patient factors that may have contributed to outcome.…”

Obesity and infection. Another comorbidity?

“…Когортные исследования свидетельствуют о связи между наличием Ож и развитием нозокомиальных инфекций в послеоперационном периоде, в частности после сердечно-сосудистых, ортопедических, гастроэнтерологических операций [28,33,34]. В нескольких исследованиях была показана более высокая частота инфекций в послеоперационном периоде у больных, подвергнутых операции аорто-коронарного шунтирования [35,36].…”

CORR Insights®: Can Patient Selection Explain the Obesity Paradox in Orthopaedic Hip Surgery? An Analysis of the ACS-NSQIP Registry

“…In their study of more than 91,000 patients, Zhang and colleagues [5] found that patients with morbid obesity (> 40 kg/m2) who underwent nonurgent hip surgery between 2011 and 2014 were less likely to die and less likely to have cardiac and respiratory complications within 30 days compared to patients with a normal weight (18.5–24.9 kg/m2). They also found that patients with morbid obesity and patients with normal weight who underwent urgent hip surgery had no differences in their odds of death within 30 days.…”

“…Zhang and colleagues [5] contend that the obesity paradox may be the result of preoperative patient selection. Indeed, it does seem to me that more attention is being paid of late to ensuring that patients are both well selected and as medically prepared as possible for elective hip surgery.…”

“…I suspect that these delays may have occurred with increasing frequency in the current study, as these alternative-payment programs have proliferated during the study period. Delaying nonurgent hip surgery to address modifiable risk factors may have reduced the risks in the nonurgent group of the study by Zhang and colleagues [5]. For example, if surgeons are more-carefully selecting patients in order to minimize complication risks, and if there are increased efforts and resources aimed at improving health conditions before elective hip surgery in order to minimize complications as we have seen in previous studies [3], then there will likely be fewer risks in the nonurgent hip surgery group.…”