Epidemiology of Obese Patients Undergoing Revision Total Knee Arthroplasty: Understanding Demographics, Comorbidities, and Propensity Weighted Analysis of Inpatient Outcomes

Abstract

Introduction:Obesity is a public health epidemic that is projected to grow in coming years. Observational data on the epidemiologic profile and immediate postoperative outcomes of obesity and morbid obesity after revision total knee arthroplasty (rTKA) are limited.Methods:Discharge data from the National Inpatient Sample was used to identify patients who underwent rTKA from 2006 to 2015. Patients were stratified into morbidly obese, obese, and not obese control cohorts. An analysis was performed to compare etiology of revision, demographic and medical comorbidity profiles, and immediate in-hospital economic and complication outcomes after rTKA.Results:An estimated 605,603 rTKAs were included in this analysis. Morbidly obese and obese patients were at significantly higher risk for any complication than not obese patients. Patients with obesity were associated with an increased risk of postoperative anemia but a lower risk of peripheral vascular disease and gastrointestinal, and hematoma/seroma complications compared with not obese patients. Patients with morbid obesity were associated with an increased risk of any, hematoma/seroma, wound dehiscence, postoperative infection, pulmonary embolism, and postoperative anemia complications and a lower risk of gastrointestinal complications when compared with not obese patients. Morbidly obese patients had a significantly longer length of stay than both obese and not obese patients, while no significant difference in length of stay was observed between obese and not obese patients.Discussion:Morbidly obese patients are at higher odds for worse postoperative medical and economic outcomes compared with those with obesity after rTKA. As the number of patients with obesity and morbid obesity continues to rise, these risk factors should be considered in preoperative discussions and perioperative protocol optimization.

Frailty Among Revision Total Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes

“…27 Multiple studies in the literature report worse outcomes and increased complications among obese patients undergoing either primary or revision arthroplasty, as compared with nonobese patients. 6,28 Current research postulates that there exists a J-shaped curve correlating BMI with complications after revision TJA, suggesting a substantial increase in complications in morbidly obese patients, as BMI gets increasingly higher. 29 In addition, studies have shown increased risk for need for revision arthroplasty among obese patients, pointing to a potential compounding effect when obesity and frailty coexist.…”

“…21, 783.22), muscular wasting and disuse atrophy (728.2), senility without mention of psychosis (797), malaise and fatigue (780.79), as validated in previous studies. [6][7][8][9][10][11][12][13] The inverse probability of treatment weighting with complex survey data was used to minimize confounding bias and adjust for comorbidity severity. Propensity score weighting was done per the method of DuGoff et al 7 by weighting patient demographics, hospital characteristics, reason and type of revision, and comorbidities using a modified version of the Elixhauser Comorbidity Index (ECI).…”

“…5 Although frailty has been shown to implicate worse postoperative outcomes in patients undergoing total joint arthroplasty (TJA), an indepth understanding of the comorbidities and demographics of frail patients undergoing rTKA is needed, as is an understanding of the effect of frailty on in-hospital medical and economic outcomes. 4,6 The aims of study were to (1) compare the demographic and comorbidities profile, (2) assess the indications and type of rTKA, and (3) compare the in-hospital clinical and economic outcomes of rTKA between frail and nonfrail cohorts.…”

The Impact of Hepatitis C on Complication Rates After Revision Total Knee Arthroplasty: A Matched Cohort Study

“…To the authors’ knowledge, this is the first analysis of complications after rTKAs in patients with HCV. As these patients often have more comorbidities than most patients undergoing an rTKA and higher comorbidity burdens are associated with an increased complication risk [ [41] , [42] , [43] , [44] ], medical optimization before an rTKA is critical in this population. Recent analyses have reported improved outcomes after a primary arthroplasty in patients with HCV who received preoperative antiviral treatment [ 16 , [45] , [46] , [47] ].…”

Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes

“…Primary total hip arthroplasty (THA) constitutes the standard of care for treatment of end-stage hip osteoarthritis and provides pain relief and improved joint function [ 1 ]. The prevalence of THA in the United States among adults fifty years of age or older was estimated to be 2.34% in 2010.…”