Journal article
Are surgeons still performing primary total knee arthroplasty in the morbidly obese?
The bone & joint journal, Vol.103-B(6 Supple A), pp.38-44
06/01/2021
DOI: 10.1302/0301-620X.103B6.BJJ-2020-1966.R1
PMID: 34053298
Abstract
Aims
The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred.
Methods
Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m
2
and ≥ 40 kg/m
2
and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses.
Results
In total, 314,695 patients underwent TKA and 46,362 (15%) had BMI ≥ 40 kg/m
2
. The prevalence of morbid obesity among TKA patients did not change greatly, ranging between 14% and 16%. Reoperation rate decreased from 1.16% to 0.96% (odds ratio (OR) 0.81 (95% confidence interval (CI) 0.66 to 0.99)) for patients with BMI < 40 kg/m
2
, as did rates of readmission (4.46% to 2.87%; OR 0.61 (0.55 to 0.69)). Patients with BMI ≥ 40 kg/m
2
also had fewer readmissions over the study period (4.87% to 3.34%; OR 0.64 (0.49 to 0.83)); however, the rate of reoperation did not change (1.37% to 1.41%; OR 0.99 (0.62 to 1.56)). Significant improvements were not observed for infective complications over time for either group; patients with BMI ≥ 40 kg/m
2
had increased risk of both deep infection and wound complications compared to non-morbidly obese patients. Rate of any complication decreased for all patients.
Conclusion
The proportion of TKAs in morbidly obese patients has not significantly changed over the past decade. Although readmission rates improved for all patients, reductions in reoperation in non-morbidly obese patients were not experienced by the morbidly obese, resulting in a widening of the complication gap between these cohorts. Care improvements have not lowered the differential risk of infective complications in the morbidly obese. Cite this article: Bone Joint J 2021;103-B(6 Supple A):38–44.
Details
- Title: Subtitle
- Are surgeons still performing primary total knee arthroplasty in the morbidly obese?
- Creators
- David E. DeMik - University of IowaChristopher N. Carender - University of IowaNatalie A. Glass - University of IowaTimothy S. Brown - University of IowaJohn J. Callaghan - University of IowaNicholas A. Bedard - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The bone & joint journal, Vol.103-B(6 Supple A), pp.38-44
- DOI
- 10.1302/0301-620X.103B6.BJJ-2020-1966.R1
- PMID
- 34053298
- ISSN
- 2049-4394
- eISSN
- 2049-4408
- Language
- English
- Date published
- 06/01/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
- Record Identifier
- 9984548857702771
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