Complications of Morbid Obesity in Total Joint Arthroplasty: Risk Stratification Based on BMI

Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty

“…However, the most influential finding 118 in the current study is that in severely obese patients, the rate of deep infection requiring 119 revision increased to 2.5%, compared to 0.35% in those patients with BMI below 120 Multiple previous reports have demonstrated obesity as a known risk factor for 133 wound complication and less favorable outcomes following THA regardless of surgical 134 approach. [3,5,12,13] Negative health impacts of being obese have been well-135 documented and are related to systemic medical conditions such as diabetes mellitus, 136 renal disease, and coronary artery disease. [1,2] The results of the current study 137 demonstrated a larger differential between study Groups 1 and 2 with respect to deep 138 infection rates compared to superficial wound dehiscence rates (Table 3).…”

“…With the combination of increasing demand for total hip arthroplasty 23 (THA) and the obesity epidemic that plagues our country, complications associated with 24 increased body mass index (BMI) will continue to rise [5]. Few studies have reported on 25 the incidence of postoperative wound and infectious complications with the direct 26 anterior approach (DAA) to THA.…”

Morbid obesity and perioperative complications

“…Recently the International Diabetes Federation, National Heart, Lung, and Blood Institute, American Heart Association, and other major organizations released a statement in an attempt to unify the definition of metabolic syndrome to at least three of the following five criteria: elevated waist circumference (no specific cutoff listed as this metric varies by sex, ethnicity, and region), triglycerides at least 150 mg/dl, highdensity lipoprotein less than 40 mg/dl in men or less than 50 mg/dl in women, SBP at least 130 mmHg and/or diastolic at least 85 mmHg, and fasting glucose at least 100 mg/dl [4]. By these criteria, it would seem logical to conclude that obese patients with metabolic syndrome would be at higher risk of postoperative cardiovascular complications; however, the recent literature does not uniformly support this concept [5,6 && ]. A multivariable regression analysis of total joint arthroplasties in the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database showed that a BMI at least 40 kg/m 2 was an independent predictor for cardiac arrest requiring cardiopulmonary resuscitation [odds ratio (OR) 3.94, confidence interval (CI) 1.87-8.3] compared with those with a BMI less than 40 kg/m 2 [5].…”

Arthroplasty Features in Overweight Patients (Review)

“…По данным статистического анализа ре-зультатов лечения 22 808 пациентов, в ко-нечном итоге ИМТ>40 однозначно является независимым предиктором для комбиниро-ванных интра-и послеоперационных осложне -ний [52].…”