Outcomes and Complications Following Total Hip Arthroplasty in the Super-Obese Patient, BMI &gt; 50

Arsoy, Diren; Woodcock, Jessica A.; Lewallen, David G.; Trousdale, Robert T.

doi:10.1016/j.arth.2014.06.022

Cited by 47 publications

(33 citation statements)

References 17 publications

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“…Several complications in the super obese patients had elevated HRs compared with the complications in patients of normal weight, including periprosthetic joint infection (HR, 6.48; 95% CI, 4.54-9.25; p \ 0.001), readmission (HR, 2.16; 95% CI, 1.84-2.54; p \ 0.001), and wound dehiscence (HR, 9.81; 95% CI, 6.31-15.24; p \ 0.001) ( Table 4). These three complications also showed an increase in risk in patients who were super obese compared with patients with a BMI of 40 to 49 kg/m 2 We found a strong dose response relationship between increasing BMI and an increased likelihood of the patient having a periprosthetic joint infection develop, readmission, renal failure, and wound dehiscence, and a weaker relationship between increasing BMI and the risk of death and postoperative pneumonia. Risks increased …”

Section: -Day Complicationsmentioning

confidence: 54%

“…There is disagreement regarding whether these individuals have greater surgical risks and costs for the episode of care [2,4,6,10] and the magnitude of those risks and costs. Further, there is no established threshold for obesity as defined by BMI in defining increased complications and risks.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, super obesity (BMI C 50 kg/m 2 ) has been reported to pose an even more substantial risk compared with the risk in patients who are less obese (BMI \ 50 kg/m 2 ) [8,15,23]. However, few peer-reviewed studies have addressed the surgical dilemma regarding whether to perform THA on patients who are morbidly obese or super obese [2,6,16,23].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies of complications in patients who are super obese were done in single institutions and focused on surgical complications rather than patient complications or costs involved [2,23,25]. However, to our knowledge, a nationwide study has not been performed on risks and costs when stratified by the degree of obesity, as measured by BMI.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with morbid obesity, defined as a BMI greater than 40 kg/m 2 , and super obesity, defined as a BMI greater than 50 kg/m 2 , increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m 2 to delineate risks, complications, and costs for these patients. Questions/purposes We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI C 40 kg/m 2 ) or super obese (BMI C 50 kg/m 2 ). Methods This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed via electronic collaboration at the authors' institutions. (HR, 3.91; 95% CI, 3.14-4.86; p \ 0.001). In addition, patients with morbid obesity had increased risk of deep vein thrombosis (HR, 1.43; 95% CI, 1.14-1.79; p \ 0.002), pulmonary embolism (HR, 1.57; 95% CI, 1.25-1.99; p \ 0.001), implant failure (HR, 1.48; 95% CI, 1.3-1.68; p \ 0.001), acute ...

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Section: -Day Complicationsmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Marks R (2016) Hip osteoarthritis surgical profiles and morbid obesity: a case series and literature review Arsoyet al [32] The results of total hip arthroplasty in 42 primary total hip arthroplasties in super-obese patients (BMI ≥ 50) were reviewed.…”

mentioning

confidence: 99%

Hip osteoarthritis surgical profiles and morbid obesity: a case series and literature review

Marks¹

2016

Clin Case Rep Rev

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Perioperative Nutrition in the Orthopedic Surgical Patient

Chin

2020

Perioperative Care of the Orthopedic Patient

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Outcomes and Complications Following Total Hip Arthroplasty in the Super-Obese Patient, BMI > 50

Cited by 47 publications

References 17 publications

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Hip osteoarthritis surgical profiles and morbid obesity: a case series and literature review

Perioperative Nutrition in the Orthopedic Surgical Patient

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