Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery

Tabatabai, Sanam; Do, Quyen; Min, Jie; Tang, Christopher; Pleasants, Devon; Sands, Laura P.; Du, Pang; Leung, Jacqueline M.

doi:10.1016/j.jclinane.2021.110475

Cited by 6 publications

(4 citation statements)

References 43 publications

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“…Although this result is supported by previous studies, [4][5][6] caution should be exercised in generalizing our results, which were based on univariate analysis only. Obesity has been reported to increase the risk of postoperative comorbidities and prolonged hospital stay, 29 and the results of this study showed that the PHFKP group had a higher BMI. In the future, we need to analyze the prolonged hospital stay of PHFKP patients from multiple factors, including BMI.…”

Section: Discussionmentioning

confidence: 50%

Predictors of post‐hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

Kaizu

Miyata

Arii

2022

PM&R

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Background: Post-hip fracture knee pain (PHFKP) is an important issue that contributes to reduced gait speed and prolonged hospitalization. Femoral morphology has been reported to contribute to the development of PHFKP, but an independent association has not been confirmed and clinically applicable cutoffs for predicting the development of PHFKP remain unclear. Objective: To determine whether femoral morphology and knee extension range of motion limitation are independent factors in PHFKP and to determine cutoffs for predicting the development of PHFKP. Design: Retrospective chart review study. Setting: Convalescent inpatient rehabilitation hospital. Participants: Patients in a convalescent ward after intertrochanteric femoral fracture surgery. Main Outcome Measures: PHFKP development, radiographic femoral morphology (leg length discrepancy and neck-shaft angle), and knee extension range of motion limitation. Results: PHFKP developed in 36 (35%) of the 103 patients enrolled. The PHFKP group had a longer hospital stay (p = .029), greater weight (p = .031), greater knee extension range of motion limitation (p = .001), and more varus neck-shaft angle (p < .001) compared to the non-PHFKP group. Varus neckshaft angle (odds ratio, 0.85; 95% confidence interval [CI], 0.78-0.92; p < .001) and knee extension range of motion limitation (odds ratio, 1.18; 95% CI, 1.07-1.30; p = .001) were significant factors for PHFKP development. Neck-shaft angle discrepancy and knee extension range of motion limitation demonstrated moderate accuracy in discriminating development of PHFKP according to receiver operating characteristic analysis, with cutoffs of 9.6 and 7.5 , respectively. Areas under the receiver operating characteristic curve were 0.77 (95% CI, 0.66-0.88; p < .001) for neck-shaft angle discrepancy and 0.67 (95% CI, 0.56-0.79; p = .004) for knee extension range of motion limitation. Conclusions: Varus neck-shaft angle and knee extension range of motion limitation were identified as independent predictors of PHFKP. The cutoff for neckshaft angle may be useful for predicting PHFKP development and to define an acceptable angle of fracture reduction to prevent PHFKP.

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Section: Discussionmentioning

confidence: 50%

Predictors of post‐hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

Kaizu

Miyata

Arii

2022

PM&R

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“…While most of recent investigations [ 35 , 36 , 37 ] focused on machine learning algorithms for the definition of predictors for increased LOS, we believe that variable selection and model development should begin from accurate classical statistical modeling, paying attention to dependent distribution in real-world datasets. In fact, in recent literature, only the paper by Tabatabai et al [ 38 ] used a negative binomial regression for duration of hospitalization, acknowledging that LOS in days has a discrete distribution with overdispersion, thus different from classic Poisson distribution.…”

Section: Discussionmentioning

confidence: 99%

Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty—Our Experience on 743 Cases

Papalia

Zampogna

Torre

et al. 2021

JCM

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The aim of this retrospective investigation is to evaluate the correlation between several preoperative and perioperative factors and the length of hospital stay in patients that underwent elective total hip arthroplasty with overnight admission. Medical records of patients that underwent THA from the beginning of 2016 to the end of 2018 were retrospectively screened. Demographics, comorbidities, whole blood count, intraoperative details, and length of postoperative stay were retrieved. The association between clinical, laboratory and surgical factors and the length of hospital stay was explored by means of negative binomial and logistic regression models. The median length of postoperative hospital stay was four days (Inter Quartile Range, IQR 3, 5). After univariate regression a stepwise multivariate regression showed that operative time (p = 0.001), the preoperative serum creatinine (p < 0.001), the intraoperative blood loss (p = 0.04) and the use of an anterolateral approach (p < 0.001) were found to correlate significantly with the increase of the hospitalization length, while no significant correlation was found for all the other features. Multivariable model fitted through logistic regression (LOS below or over the median value of four days) had an Area Under the Curve (AUC) of 0.748. Our analysis suggests a significant role played by different preoperative and perioperative variables in influencing the length of hospital stay.

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“…4 Additionally, obesity has also been shown to be an independent risk factor for postoperative complications related to surgical site infections (SSIs), venous thromboembolism, and blood loss in patients undergoing spine surgery. [5][6][7][8] However, recent studies have begun to describe an obesity paradox in which patients considered underweight (BMI <18.5) may be at a similar or greater risk of postsurgical complications compared with obese individuals. 9 Underweight patients have been shown to be at an increased risk of postoperative complications across multiple surgical disciplines, including nonbariatric general surgery, 10,11 total joint replacement, 12,13 and spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Low Body Mass Index Patients Undergoing an Anterior Lumbar Fusion May Have an Increased Risk of Perioperative Complications

Gleeson,

Solomito,

Kostyun

et al. 2023

Int J Spine Surg

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Background: Previous research has shown that underweight patients may be at a greater risk of experiencing postsurgical complications. The purpose of this study was to investigate the association between body mass index (BMI) and postoperative complications following single-level anterior lumbar fusion (ALF).Methods: All single-level elective ALF procedures performed between 2010 and 2020 were identified in the PearlDiver Mariner Database. Patients were separated into 6 groups based on the World Health Organization BMI classifications. Differences in postsurgical complications (ie, deep vein thrombosis, pulmonary embolism, surgical site infection, hardware malfunction, wound dehiscence, and blood transfusion) among BMI categories were assessed using a χ 2 contingency test.Results: Results indicated that underweight patients (BMI <20) were at a significantly greater risk of developing deep vein thromboses, experiencing hardware malfunction, and requiring blood transfusion compared with any other BMI classification (P < 0.001). Results also demonstrated that underweight individuals had similar risks of developing surgical site infection and wound dehiscence compared with patients classified as having obesity class III.Conclusion: Underweight patients may be at a greater risk than currently believed of experiencing postoperative complications following single-level ALF procedures.Clinical Relevance: Patients with a BMI of 20 or less should be carefully evaluated prior to surgical intervention to ensure they are optimized for surgery.Level of Evidence: 3.

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Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery

Cited by 6 publications

References 43 publications

Predictors of post‐hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

Predictors of post‐hip fracture knee pain in hospitalized older adults with intertrochanteric femoral fracture

Preoperative and Perioperative Predictors of Length of Hospital Stay after Primary Total Hip Arthroplasty—Our Experience on 743 Cases

Low Body Mass Index Patients Undergoing an Anterior Lumbar Fusion May Have an Increased Risk of Perioperative Complications

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