title: Complications of Morbid Obesity in Total Joint Arthroplasty: Risk Stratification Based on BMI.
abstract: This study stratifies complication risk in primary total joint arthroplasty (TJA) based on body mass index (BMI). Demographics, co-morbidities, perioperative variables, and complications were reviewed for 22,808 patients. Chi-squared, one-way ANOVA, univariate and multivariable regression analysis were performed. Increasing BMI led to an increase (P<0.05) in combined complications, acute kidney injury (AKI), cardiac arrest (CA), reintubation, reoperation, and superficial infection (SI). Univariate analysis for BMI>40 revealed an increase in combined complications (15.21-vs-17.40%), AKI (1.93-vs-3.87%), CA (0.22-vs-0.57%), reintubation (0.47-vs-0.95%), reoperation (2.36-vs-3.37%), and SI (0.82-vs-1.65%). Multivariable regression showed BMI>40 as an independent predictor for combined complications (OR=1.18), AKI (OR=1.79), CA (OR=3.94), reintubation (OR=2.56), reoperation (OR=1.44), and SI (OR=2.11). Morbid obesity confers increased risk for complications in TJA.
authors.affiliation: University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, California.
authors.forename: Derek T
authors.initials: DT
authors.lastname: Ward
authors.affiliation: University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, California.
authors.forename: Lionel N
authors.initials: LN
authors.lastname: Metz
authors.affiliation: University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, California.
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Horst
authors.affiliation: San Francisco Department of Veterans Affairs, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Hubert T
authors.initials: HT
authors.lastname: Kim
authors.affiliation: San Francisco Department of Veterans Affairs, Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Kuo
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015992:Body Mass Index; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D010003:Osteoarthritis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014946:Wound Infection
keywords: obesity; postoperative complications; primary total hip arthroplasty; primary total knee arthroplasty; total joint arthroplasty