Elke Jeschke1, Mustafa Citak2, Christian Günster1, Andreas M Halder3, Karl-Dieter Heller4, Jürgen Malzahn5, Fritz U Niethard6, Peter Schräder7, Josef Zacher8, Thorsten Gehrke2. 1. Research Institute of the Local Health Care Funds, Berlin, Germany. 2. Department of Orthopaedic Surgery, Helios Endo-Klinik Hamburg, Hamburg, Germany. 3. Department of Orthopaedic Surgery, Sana Kliniken Sommerfeld, Sommerfeld, Germany. 4. Department of Orthopaedic Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany. 5. Federal Association of the Local Health Care Funds, Berlin, Germany. 6. German Society of Orthopedics and Orthopedic Surgery, Berlin, Germany. 7. Department of Orthopaedic Surgery, Kreisklinik Jugenheim, Seeheim-Jugenheim, Germany. 8. Helios Kliniken GmbH, Berlin, Germany.
Abstract
BACKGROUND: The aim of our study is to evaluate the association of body mass index (BMI) and the risk of postoperative complications, mortality, and revision rates following primary total hip arthroplasty given other potentially confounding patient characteristics in a large cohort study. METHODS: Using nationwide billing data for inpatient hospital treatment of the biggest German healthcare insurance, 131,576 total hip arthroplasties in 124,368 patients between January 2012 and December 2014 were included. Outcomes were 90-day mortality, 1-year revision procedures (with and without removal or exchange of implants), 90-day surgical complications, 90-day femoral fractures, and overall complications. The effect of BMI on outcome was analyzed using multivariable logistic regression. Risk-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: BMI had a significant effect on overall complications (30-34 in kg/m2: OR 1.1, CI 1.0-1.2, P = .014; 35-39: OR 1.5, CI 1.3-1.6, P < .001; ≥40: OR 2.1, CI 1.9-2.3, P < .001; <30: reference). The OR for 1-year revision procedures (30-34: OR 1.2, CI 1.1-1.4, P = .001; 35-39: OR 1.6, CI 1.4-1.8, P < .001; ≥40: OR 2.4, CI 2.1-2.7, P < .001; <30: reference) and 90-day surgical complications increased with every BMI category. For mortality and periprosthetic fractures there was a higher risk only for patients with BMI ≥40. CONCLUSION: BMI increases the risk of revision rates in a liner trend. Therefore, the authors believe that patients with a BMI >40 kg/m2 should be sent to obesity medicine physicians in order to decrease the body weight prior elective surgery.
BACKGROUND: The aim of our study is to evaluate the association of body mass index (BMI) and the risk of postoperative complications, mortality, and revision rates following primary total hip arthroplasty given other potentially confounding patient characteristics in a large cohort study. METHODS: Using nationwide billing data for inpatient hospital treatment of the biggest German healthcare insurance, 131,576 total hip arthroplasties in 124,368 patients between January 2012 and December 2014 were included. Outcomes were 90-day mortality, 1-year revision procedures (with and without removal or exchange of implants), 90-day surgical complications, 90-day femoral fractures, and overall complications. The effect of BMI on outcome was analyzed using multivariable logistic regression. Risk-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: BMI had a significant effect on overall complications (30-34 in kg/m2: OR 1.1, CI 1.0-1.2, P = .014; 35-39: OR 1.5, CI 1.3-1.6, P < .001; ≥40: OR 2.1, CI 1.9-2.3, P < .001; <30: reference). The OR for 1-year revision procedures (30-34: OR 1.2, CI 1.1-1.4, P = .001; 35-39: OR 1.6, CI 1.4-1.8, P < .001; ≥40: OR 2.4, CI 2.1-2.7, P < .001; <30: reference) and 90-day surgical complications increased with every BMI category. For mortality and periprosthetic fractures there was a higher risk only for patients with BMI ≥40. CONCLUSION: BMI increases the risk of revision rates in a liner trend. Therefore, the authors believe that patients with a BMI >40 kg/m2 should be sent to obesity medicine physicians in order to decrease the body weight prior elective surgery.
Authors: Jamie R Robinson; Robert J Carroll; Lisa Bastarache; Qingxia Chen; Zongyang Mou; Wei-Qi Wei; John J Connolly; Frank Mentch; Patrick Sleiman; Paul K Crane; Scott J Hebbring; Ian B Stanaway; David R Crosslin; Adam S Gordon; Elisabeth A Rosenthal; David Carrell; M Geoffrey Hayes; Wei Wei; Lynn Petukhova; Bahram Namjou; Ge Zhang; Maya S Safarova; Nephi A Walton; Christopher Still; Erwin P Bottinger; Ruth J F Loos; Shawn N Murphy; Gretchen P Jackson; Iftikhar J Kullo; Hakon Hakonarson; Gail P Jarvik; Eric B Larson; Chunhua Weng; Dan M Roden; Joshua C Denny Journal: World J Surg Date: 2020-01 Impact factor: 3.352
Authors: David T Burke; Daniel P Burke; Samir Al-Adawi; Tracie McCargo; Regina B Bell; Sathiya M Panchatcharam Journal: Arch Rehabil Res Clin Transl Date: 2019-08-29