BACKGROUND: We compared 90-day costs and outcomes for primary total knee arthroplasty patients among nonobese (body mass index [BMI] 18.5-24.9), overweight (25-29.9), obese (30-34.9), severely obese (35-39.9), morbidly obese (40-49.9), and super-obese (50+) cohorts. METHODS: We conducted a retrospective review of an institutional database of total knee arthroplasty patients from 2006 to 2013 with a minimum of 3-year follow-up. Sixty-five super-obese patients were identified, and five other cohorts were randomly selected in a 2:1 ratio (total, n = 715). Demographics, 90-day outcomes (costs, reoperations, and readmissions), and outcomes after 3 years (revisions and change scores for Short-Form Health Survey [SF-12], Knee Society Scores, and Western Ontario and McMaster Universities Arthritis Index) were aggregated. RESULTS: The 90-day costs were significantly greater in the morbidly obese ($11,568 ± $1,960) and super-obese ($14,021 ± $7,903) cohorts relative to the smaller BMI cohorts ($9,938 - $10,352). The increased cost from readmissions was the main driver of costs. The outcome change scores were similar across all the BMI cohorts for Knee Society Scores, SF-12 Mental Health Composite Score, and Western Ontario and McMaster Universities Arthritis Index, but not for the SF-12 Physical Health Composite Score. At the midterm follow-up, there was no statistical difference in repeat surgery or aseptic revision rates. Septic revisions were significantly greater in the super-obese cohort relative to the other cohorts (6.2% vs 0.8-3.1%). CONCLUSION: Health-care policy based purely on the economic costs may place morbidly obese and super-obese patients at risk of losing arthroplasty care, thereby denying them access to the comparable quality of life improvements.
BACKGROUND: We compared 90-day costs and outcomes for primary total knee arthroplastypatients among nonobese (body mass index [BMI] 18.5-24.9), overweight (25-29.9), obese (30-34.9), severely obese (35-39.9), morbidly obese (40-49.9), and super-obese (50+) cohorts. METHODS: We conducted a retrospective review of an institutional database of total knee arthroplasty patients from 2006 to 2013 with a minimum of 3-year follow-up. Sixty-five super-obesepatients were identified, and five other cohorts were randomly selected in a 2:1 ratio (total, n = 715). Demographics, 90-day outcomes (costs, reoperations, and readmissions), and outcomes after 3 years (revisions and change scores for Short-Form Health Survey [SF-12], Knee Society Scores, and Western Ontario and McMaster Universities Arthritis Index) were aggregated. RESULTS: The 90-day costs were significantly greater in the morbidly obese ($11,568 ± $1,960) and super-obese ($14,021 ± $7,903) cohorts relative to the smaller BMI cohorts ($9,938 - $10,352). The increased cost from readmissions was the main driver of costs. The outcome change scores were similar across all the BMI cohorts for Knee Society Scores, SF-12 Mental Health Composite Score, and Western Ontario and McMaster Universities Arthritis Index, but not for the SF-12 Physical Health Composite Score. At the midterm follow-up, there was no statistical difference in repeat surgery or aseptic revision rates. Septic revisions were significantly greater in the super-obese cohort relative to the other cohorts (6.2% vs 0.8-3.1%). CONCLUSION: Health-care policy based purely on the economic costs may place morbidly obese and super-obesepatients at risk of losing arthroplasty care, thereby denying them access to the comparable quality of life improvements.
Authors: Alexandre Coelho; Joan Leal-Blanquet; Juan Francisco Sánchez-Soler; Raúl Torres-Claramunt; Pedro Hinarejos; Joan Carles Monllau Journal: Int Orthop Date: 2022-03-29 Impact factor: 3.479
Authors: Mina W Morcos; Paul Kooner; Jackie Marsh; James Howard; Brent Lanting; Edward Vasarhelyi Journal: Can J Surg Date: 2021-03-05 Impact factor: 2.089