Primary reverse shoulder arthroplasty in patients with metabolic syndrome is associated with increased rates of deep infection

Marigi, Erick M.; Marigi, Ian; Crowe, Matthew M.; Ortiguera, Cedric J.; Ledford, Cameron K.; Werthel, Jean‐David; Sperling, John W.; Sánchez-Sotelo, Joaquín; Schoch, Bradley S.

doi:10.1016/j.jse.2020.12.025

Cited by 16 publications

(6 citation statements)

References 34 publications

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“… 20 Marigi et al reported rates of deep infection, joint instability, venous thrombosis, and pulmonary embolism to be significantly higher in the MetS group following TSA. 17 However, a study by Garcia et al on TSA patients from 2005-2013 did not find MetS to be an independent predictor of adverse postoperative outcomes. 5 Therefore, along with the rise in TSA utilization, it is important to clarify this potential increased risk of the MetS patient population.…”

Section: Discussionmentioning

confidence: 94%

Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity

Fassler,

Ling,

Burgan

et al. 2024

JSES International

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Section: Discussionmentioning

confidence: 94%

Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity

Fassler,

Ling,

Burgan

et al. 2024

JSES International

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“…Our findings are consistent with the current literature on the subject. The greater risk of complications in patients with MetS is well documented in both orthopaedic surgery 35,[37][38][39][40][41] and other surgical fields. 32,[42][43][44][45] Cichos et al, 46 in a similar study assessing perioperative outcomes in hip fracture, found MetS increased complications, but reduced mortality.…”

Section: Discussionmentioning

confidence: 99%

A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients

Singh,

Kotzur,

Vivancos-Koopman

et al. 2024

OTA International

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Introduction: Hip fractures are a common injury associated with significant morbidity and mortality. In the United States, there has been a rapid increase in the prevalence of metabolic syndrome (MetS), a condition comprised several common comorbidities, including obesity, diabetes mellitus, and hypertension, that may worsen perioperative outcomes. This article assesses the impact of MetS and its components on outcomes after hip fracture surgery. Methods: Patients who underwent nonelective operative treatment for traumatic hip fractures were identified in the 2015–2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Baseline characteristics between groups were compared, and significant differences were included as covariates. Multivariate regression was performed to assess the impact of characteristics of interest on postoperative outcomes. Patients with MetS, or a single one of its constitutive components—hypertension, diabetes, and obesity—were compared with metabolically healthy cohorts. Results: In total 95,338 patients were included. Patients with MetS had increased complications (OR 1.509; P < 0.001), but reduced mortality (OR 0.71; P < 0.001). Obesity alone was also associated with increased complications (OR 1.14; P < 0.001) and reduced mortality (OR 0.736; P < 0.001). Both hypertension and diabetes alone increased complications (P < 0.001) but had no impact on mortality. Patients with MetS did, however, have greater odds of adverse discharge (OR 1.516; P < 0.001), extended hospital stays (OR 1.18; P < 0.001), and reoperation (OR 1.297; P = 0.003), but no significant difference in readmission rate. Conclusion: Patients with MetS had increased complications but decreased mortality. Our component-based analysis showed had obesity had a similar effect: increased complications but lower mortality. These results may help surgeons preoperatively counsel patients with hip fracture about their postoperative risks.

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“…39 Although we controlled for potential confounders, such as smoking, diabetes, and comorbidities, including cardiac, pulmonary, and renal, this is subject to classification bias. Furthermore, high BMI is associated with metabolic syndrome and corresponding comorbidities associated with poor surgical outcomes 40 ; this study is not intended to minimize these facts but rather shed light on the potential pitfalls of BMI as a cutoff. Another limitation of the ACS-NSQIP database is that it is compiled by healthcare entities that have the resources to voluntarily opt-in and contribute data, which may affect the representation of the population in comparison with the rest of the United States.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty

Hones,

Hao,

Cueto

et al. 2023

J Am Acad Orthop Surg

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Background: An inverse relationship coined the “obesity paradox” has been propositioned, in which body mass index (BMI) may be contradictorily protective in patients undergoing surgery or treatment of chronic disease. This study sought to investigate the BMI associated with the lowest rate of medical complications after total shoulder arthroplasty (TSA). Methods: The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify adults who underwent elective primary TSA between January 2012 and December 2020. Thirty-day postoperative medical complications were extracted, which included death, readmission, pneumonia, pulmonary embolism, renal failure, and cardiac arrest, among others. BMI was classified into five categories (underweight [BMI <18.5 kg/m2], normal weight [BMI ≥18.5 and <25 kg/m2], overweight [BMI ≥25 and <30 kg/m2], obese [BMI ≥30 and <40 kg/m2], and morbidly obese [BMI ≥40 kg/m2]). We examined the risk of any 30-day postoperative complications and BMI categorically and on a continuous basis using multivariable logistic regression controlling for age, sex, procedure year, and comorbidities. Results: Of the 31,755 TSAs, 84% were White, 56% were female, and the average age of patients was 69.2 ± 9.3 years. Thirty-day postoperative medical complications occurred in 4.53% (n = 1,440). When assessed on a continuous basis, the lowest risk was in patients with a BMI between 30 and 35 kg/m2. Underweight individuals (BMI <18.5 kg/m2) had the highest postoperative complication rates overall. The probability of medical complications increased with age and was greater for female patients. Conclusion: The relationship between BMI and complication risk in TSA is nonlinear. A BMI between 30 and 35 kg/m2 was associated with the lowest risk of medical complications after TSA, and BMI<18.5 kg/m2 had the highest risk overall, indicating some protective aspects of BMI against 30-day medical complications. Thus, obesity alone should not preclude patients from TSA eligibility, rather surgical candidacy should be evaluated in the context of patients' overall health and likelihood of benefit from TSA. Level of evidence: III, Retrospective Comparative Study.

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Primary reverse shoulder arthroplasty in patients with metabolic syndrome is associated with increased rates of deep infection

Cited by 16 publications

References 34 publications

Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity

Components of metabolic syndrome as significant risk factors for postoperative complications following total shoulder arthroplasty: hypertension, diabetes, and obesity

A component-based analysis of metabolic syndrome's impact on 30-day outcomes after hip fracture: reduced mortality in obese patients

The Obesity Paradox: A Nonlinear Relationship Between 30-Day Postoperative Complications and Body Mass Index After Total Shoulder Arthroplasty

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