The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA

D’Apuzzo, Michele R.; Novicoff, Wendy M.; Browne, James A.

doi:10.1007/s11999-014-3668-9

Cited by 228 publications

(138 citation statements)

References 33 publications

(48 reference statements)

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“…Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications in patients after TKA [5,6,10,12,31]. In addition, both often are considered modifiable risk factors, and some surgeons suggest that they should be corrected before elective TKA [1,12].…”

Section: Discussionmentioning

confidence: 99%

“…Benefits of TKA in populations at greater risk for complications are less well defined. Morbid obesity and malnutrition have been shown to be associated with increased perioperative complications after TKA [5,6,10,12,16,18,19,27,32]; however, some studies have not shown an increased risk of perioperative complications in patients who are morbidly obese [3,13,14,23,25]. In addition, patients with morbid obesity are more likely to be malnourished than patients who are not obese, raising the question whether morbid obesity, malnutrition, or both, are independently associated with increased perioperative complications [12].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

140

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Background Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions. Questions/purposes We asked: (1) Is morbid obesity independently associated with more frequent major perioperative complications after TKA? (2) Are major perioperative complications after TKA more prevalent among patients with a low serum albumin? Methods The National Surgical Quality Improvement Program (NSQIP) database was analyzed from 2006 to 2013. Patients were grouped as morbidly obese (BMI C 40 kg/m 2 ) or nonmorbidly obese (BMI C 18.5 kg/m 2 to \ 40 kg/m 2 ), or by low serum albumin (serum albumin level \ 3.5 mg/dL) or normal serum albumin (serum albumin level C 3.5 mg/dL). The study cohort included 77,785 patients, including 35,573 patients with a serum albumin level of 3.5 g/dL or greater and 1570 patients with a serum albumin level less than 3.5 g/dL. Therefore, serum albumin levels were available for only 37,173 of the 77,785 of the patients (48%). There were 66,382 patients with a BMI between 18.5 kg/m 2 and 40 kg/m 2 and 11,403 patients with a BMI greater than 40 kg/m 2 . Data were recorded on patient mortality along with 21 complications reported in the NSQIP. We also developed three composite complication variables to represent risk of any infections, cardiac or pulmonary complications, and any major complications. For each complication, multivariate logistic regression analysis was performed. Independent variables included patient age, sex, race, BMI, American Society of Anesthesiologists classification, year of surgery, and Charlson comorbidity index score. Results Mortality was not increased in the morbidly obese group (0.14% vs 0.14%; p = 0.942). Patients who were morbidly obese were more likely to have progressive renal insufficiency (0.30% vs 0.10%; odds ratio [OR], 2.47; 95% CI, 1.27-4.29; p \ 0.001), superficial infection (1.07% vs 0.55%; OR, 1.87; 95% CI, 1.39-2.51; p \ 0.001), and sepsis (0.36% vs 0.23%; OR, 1.70; 95% CI, 1.04-2.53; p = 0.034) compared with patients who were not morbidly obese. Patients who were morbidly obese were less likely to require blood transfusion (8.68% vs One of the authors certifies that he (CLN), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000-USD 100,000 from Zimmer Inc (Warsaw, IN, USA 12.06%; OR, 0.70; 95% CI, 0.63-0.77; p \ 0.001) compared with patients who were not morbidly obese. Morbid obesity was not associated with any of the other 21 perioperative complications recorded in the NSQIP database. With respect to the composite complication variable...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Nelson

Elkassabany

Kamath

et al. 2015

Clin Orthop Relat Res

140

View full text Add to dashboard Cite

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“…Prior studies have also evinced the influence of patient comorbidities on the utilization of resources such as office visits, emergency department (ED) visits, length of stay, drug costs, procedures, and overall costs in other study populations [33][34][35][36][37] .…”

Section: Case: the Cholecystectomy And Contributors To Resource Usementioning

confidence: 99%

Patient comorbidities increase postoperative resource utilization after laparoscopic and open cholecystectomy

Boehme

McKinley

Brunt³

et al. 2015

Surg Endosc

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“…As has been the case every year for nearly two decades now, the partnership between CORR 1 and the Knee Society has produced a collection of papers that should influence thought on the most important current issues in the treatment of the adult knee. While we could feature any of the dozens of papers from those proceedings in the spotlight section, including any of several award-winners [1,3,4], we have chosen to highlight a paper by Professor Fares S. Haddad's group in the United Kingdom on a thorny and resistant topic: Single-stage exchange revision for the infected TKA.…”

Section: T Is With Great Pride That Clinicalmentioning

confidence: 99%

Editor's Spotlight/Take 5: Is Single-stage Revision According to a Strict Protocol Effective in Treatment of Chronic Knee Arthroplasty Infections?

Leopold

2015

Clinical Orthopaedics &Amp; Related Research

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The John Insall Award: Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA

Abstract: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 228 publications

References 33 publications

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA

Patient comorbidities increase postoperative resource utilization after laparoscopic and open cholecystectomy

Editor's Spotlight/Take 5: Is Single-stage Revision According to a Strict Protocol Effective in Treatment of Chronic Knee Arthroplasty Infections?

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