title: The Interaction of Obesity and Metabolic Syndrome in Determining Risk of Complication Following Total Joint Arthroplasty.
abstract: The arthroplasty population is increasingly comorbid, and current quality improvement initiatives demand accurate risk stratification. Metabolic syndrome (MetS) has been identified as a risk factor for adverse events after arthroplasty; however, its interaction with obesity in contributing to risk is unclear.
  
  
  
  A retrospective analysis of all Medicare patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) at a single institution from 2009 to 2013 investigated the interaction between MetS, body mass index (BMI), and risk for Centers for Medicare and Medicaid Services (CMS)-reportable complications, readmission, and discharge disposition.
  
  
  
  A total of 1462 patients (942 TKA, 538 THA) were included, of which 16.2% had MetS. Regression analysis found that MetS was significantly related to risk of CMS complications (odds ratio [OR] = 1.96, 95% confidence interval [CI] 1.16-3.31, P = .012) and nonhome discharge (OR = 1.78, 95% CI 1.39-2.27, P < .001), but not readmission (OR = 1.23, 95% CI 0.7-2.18, P = .485). Within the MetS cohort, increasing BMI was not associated with increasing complications (P = .726) or readmissions (P = .206) but was associated with nonhome discharge (OR = 1.191 per unit increase in BMI, 95% CI 1.038-1.246, P = .001).
  
  
  
  MetS increases risk for CMS-reportable complications and nonhome discharge disposition after THA and TKA regardless of BMI. Obesity is of less value than MetS in assessing overall risk for complication after THA and TKA.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Adam I
authors.initials: AI
authors.lastname: Edelstein
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Linda I
authors.initials: LI
authors.lastname: Suleiman
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Alvarez
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Sacotte
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Qin
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Beal
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Manning
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D024821:Metabolic Syndrome / Q000150:complications*; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States
keywords: BMI; complications; metabolic syndrome; obesity