Does the obesity paradox apply to early postoperative complications after hip surgery? A retrospective chart review

Shaparin, Naum; Widyn, James; Nair, Saraswathy; Kho, Irene; Geller, David S.; Delphin, Ellise

doi:10.1016/j.jclinane.2015.12.037

Cited by 34 publications

(41 citation statements)

References 39 publications

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“…Amongst the different complications, the risks of both periprosthetic fractures and aseptic loosening were not significantly higher in the obese than non-obese group. An explanation for this observation is that the obese group involved a younger population group at the time of primary THA possibly due to earlier onset and accelerated progression of osteoarthritis 5e10, 41,47,48,51,53,63,65,68,71 . Hence, bone density of the obese population is likely to be better.…”

Section: Discussionmentioning

confidence: 99%

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Onggo

Steiger

et al. 2020

Osteoarthritis and Cartilage

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Background: Obesity is an epidemic, especially in developed countries. This affects the general health of these patients, especially when they are having a major surgical procedure such as total hip arthroplasty (THA). Several articles have described the effects of obesity on THA with varying conclusions. This metaanalysis aims to compare the outcomes, complications, and peri-operative parameters of THA in the obese (BMI!30 kg/m 2) vs non-obese (BMI<30 kg/m 2) population as well as a subgroup analysis of morbidly obese (BMI!40 kg/m 2) vs non-obese population. Methods: A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the outcomes and complications of THA in the obese and non-obese population were extracted and analyzed. Results: Sixty-seven studies were included in this meta-analysis, consisting of 581,012 obese and 1,609,812 non-obese patients. Meta-analysis could not be performed on patient reported outcome measures due to heterogeneous reporting methods. Obese patients had a higher risk of all complications (OR ¼ 1.53, 95%CI: 1.30e1.80, P < 0.001), deep infections (OR ¼ 2.71, 95%CI: 2.08e3.53, P < 0.001), superficial infections (OR ¼ 1.99, 95%CI: 1.55e2.55, P < 0.001), dislocations (OR ¼ 1.72, 95%CI: 1.66e1.79, P < 0.001), reoperations (OR ¼ 1.61, 95%CI: 1.40e1.85, P < 0.001), revisions (OR ¼ 1.44, 95%CI: 1.32e1.57, P < 0.001), and readmissions (OR ¼ 1.37, 95%CI: 1.15e1.63, P < 0.001). When subgroup analysis of morbidly obese (BMI!40 kg/m 2) patients was performed, the risks of all these parameters were even greater. Conclusion: Obese and morbidly obese patients are at higher risks of complications post THA than nonobese patients. Surgeons should be aware of these risks in order to counsel patients and adopt prophylactic strategies to reduce these risks where applicable.

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Section: Discussionmentioning

confidence: 99%

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Onggo

Steiger

et al. 2020

Osteoarthritis and Cartilage

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“…Although obesity was shown to increase the risk of early revision due to aseptic loosening and/or osteolysis by almost fivefold, statins were suggested to reduce femoral osteolysis in hip arthroplasty . However, some studies revealed obesity paradox, in which obesity or its correlates provided some protective effect in hip replacement . Further, the risk of femoral osteolysis in some normal‐weight patients was higher compared with overweight patients .…”

Section: Discussionmentioning

confidence: 99%

“…36 However, some studies revealed obesity paradox, in which obesity or its correlates provided some protective effect in hip replacement. 37 Further, the risk of femoral osteolysis in some normal-weight patients was higher compared with overweight patients. 38 Studies on genetically obese mice suggested that obesity may protect against particle-induced bone resorption.…”

Section: In Silico Research On Periprosthetic Osteolysismentioning

confidence: 96%

Development of an Integrated Platform Using Multidisciplinary Real‐World Data to Facilitate Biomarker Discovery for Medical Products

Dabic

Azarbaijani

Karapetyan

et al. 2019

Clinical Translational Sci

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Translational multidisciplinary research is important for the Center for Devices and Radiological Health's efforts for utilizing real‐world data (RWD) to enhance predictive evaluation of medical device performance in patient subpopulations. As part of our efforts for developing new RWD‐based evidentiary approaches, including in silico discovery of device‐related risk predictors and biomarkers, this study aims to characterize the sex/race‐related trends in hip replacement outcomes and identify corresponding candidate single nucleotide polymorphisms (SNPs). Adverse outcomes were assessed by deriving RWD from a retrospective analysis of hip replacement hospital discharge data from the National Inpatient Sample (NIS). Candidate SNPs were explored using pre‐existing data from the Personalized Medicine Research Project (PMRP). High‐Performance Integrated Virtual Environment was used for analyzing and visualizing putative associations between SNPs and adverse outcomes. Ingenuity Pathway Analysis (IPA) was used for exploring plausibility of the sex‐related candidate SNPs and characterizing gene networks associated with the variants of interest. The NIS‐based epidemiologic evidence showed that periprosthetic osteolysis (PO) was most prevalent among white men. The PMRP‐based genetic evidence associated the PO‐related male predominance with rs7121 (odds ratio = 4.89; 95% confidence interval = 1.41−17.05) and other candidate SNPs. SNP‐based IPA analysis of the expected gene expression alterations and corresponding signaling pathways suggested possible role of sex‐related metabolic factors in development of PO, which was substantiated by ad hoc epidemiologic analysis identifying the sex‐related differences in metabolic comorbidities in men vs. women with hip replacement‐related PO. Thus, our in silico study illustrates RWD‐based evidentiary approaches that may facilitate cost/time‐efficient discovery of biomarkers for informing use of medical products.

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“…21 National databases often use retrospectively collected data and the data quality is uncertain. [22][23][24] In the UK, the National Joint Registry (NJR) uses data supplied by the NHS. Details of the data quality are not given on the NJR website.…”

Section: Definitions Of Common Complicationsmentioning

confidence: 99%

“…30 We were unable to find a publication that comprehensively listed the risks and complications of THR in a way that could be used for a consent form. The reporting of complications after hip replacement seems to be in several common forms: > Specialised groups (eg the complication rate after hip replacement in obese patients) 22 > Immediate local complications for more general groups of patients: They tend to assess mainly the local complications of THR.…”

Section: Definitions Of Common Complicationsmentioning

confidence: 99%

Recognising and dealing with complications in orthopaedic surgery

Ricketts

Roper

et al. 2017

annals

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Orthopaedic surgeons need information about the complications they are likely to encounter. The literature on complications is difficult to interpret owing to a lack of agreed definitions, problems with collecting accurate data and with data interpretation. We suggest a role for the Royal College of Surgeons and specialist societies in collecting and interpreting complications data. The aim of this narrative review was to provide an overview of the medical informatics of (orthopaedic) complications. Outcome measures were not part of this review. KEYWORDS Orthopaedic -Complications

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Does the obesity paradox apply to early postoperative complications after hip surgery? A retrospective chart review

Cited by 34 publications

References 39 publications

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review

Development of an Integrated Platform Using Multidisciplinary Real‐World Data to Facilitate Biomarker Discovery for Medical Products

Recognising and dealing with complications in orthopaedic surgery

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