title: Obesity is associated with increased postoperative complications after total elbow arthroplasty.
abstract: BACKGROUND
  Obesity has become a significant public health concern in the United States. Few published data have examined the association between obesity and postoperative complications after total elbow arthroplasty (TEA).
  
  
  METHODS
  Patients who underwent TEA were identified using the PearlDiver database Current Procedural Terminology codes. Patients were divided into obese and nonobese cohorts using International Classification of Diseases, Ninth Revision codes. Each cohort was then assessed for major and minor complications within 90 days postoperatively. Odds ratios, 95% confidence intervals, and χ(2) tests were calculated, with P < .05 considered significant.
  
  
  RESULTS
  From 2005 to 2011, 7580 patients who underwent TEA were identified, of whom 1030 patients (14%) were coded as obese (body mass index > 30) and 611 patients (8%) were coded as morbidly obese (body mass index > 40). The obese TEA patients had increased risk of 90-day major and minor complications. The rate of postoperative venous thromboembolism differed significantly between groups, with a trend toward a higher venous thromboembolism rate in obese patients (2.2%) vs. nonobese patients (0.7%). Rate of postoperative stiffness was similar between groups. Infection rates were higher in obese patients compared with nonobese patients. Medical complications were higher in obese patients (16.7%) compared with the nonobese cohort (4.7%). A significant difference in implant removal was notable at 6 months and 1 year in morbidly obese patients compared with nonobese counterparts.
  
  
  CONCLUSIONS
  Obesity and associated medical comorbidities place patients at increased risk for complications after TEA. Obese patients and especially morbidly obese patients thinking of undergoing TEA should be appropriately counseled preoperatively about their increased risk for complications.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Griffin
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: F Winston
authors.initials: FW
authors.lastname: Gwathmey
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: AC2H@hscmail.mcc.virginia.edu.
authors.forename: A Bobby
authors.initials: AB
authors.lastname: Chhabra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D015992:Body Mass Index; D015897:Comorbidity; D020878:Device Removal / Q000706:statistics & numerical data; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology*; D016059:Range of Motion, Articular; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology
keywords: Total elbow arthroplasty; elbow stiffness; obesity; perioperative risk assessment; postoperative complications; revision total elbow