Morbidly Obese, Diabetic, Younger, and Unilateral Joint Arthroplasty Patients Have Elevated Total Joint Arthroplasty Infection Rates

Malinzak, Robert A.; Ritter, Merrill A.; Berend, Michael E.; Meding, John B.; Olberding, Emily M.; Davis, Kenneth

doi:10.1016/j.arth.2009.05.016

Cited by 328 publications

(223 citation statements)

References 24 publications

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“…The correlation was independent of diabetes and cardiovascular disease, which we did not account for in our analyses. Another retrospective analysis with an average followup of 6 years and a smaller patient population than our study reported that morbid obesity and diabetes were significant risk factors for surgical wound infection after THA or TKA [13].…”

Section: Discussioncontrasting

confidence: 52%

“…The effects of obesity on outcomes such as venous thromboembolism (VTE), wound complications, infection, and bleeding in patients undergoing total joint arthroplasties have been documented in numerous studies [4,6,7,13,15,18,20,21]. However, large studies to determine the effect size of morbid obesity on early postoperative complications after THA or TKA are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Friedman¹,

Hess

Berkowitz

et al. 2013

Clinical Orthopaedics &Amp; Related Research

166

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Background Morbid obesity has been shown to be a risk factor for increased complications after THA and TKA; however, large studies that would determine the effect size are lacking. Questions/purposes The purposes of this study were to determine whether morbid obesity increased the risk of: (1) venous thromboembolism (VTE), (2) bleeding, (3) other adverse events, and (4) infections during the early postoperative period (up to 6 to 8 weeks) after THA or TKA? Methods Data from the REgulation of Coagulation in ORthopaedic surgery to prevent Deep vein thrombosis and pulmonary embolism (RECORD) clinical trial program of rivaroxaban for prevention of VTE after THA or TKA were analyzed retrospectively. Data for 12,355 patients were reviewed to identify complication rates in morbidly obese patients (BMI C 40 kg/m 2 ) compared with patients with a BMI less than 40 kg/m 2 . Explorative analyses compared the rates of asymptomatic deep vein thrombosis (DVT), symptomatic DVT, symptomatic pulmonary embolism, bleeding, and other adverse events by BMI group. Results There were no significant differences in asymptomatic DVT, symptomatic DVT, symptomatic pulmonary embolism, or bleeding, but there were increases in other adverse events (including receipt of blood transfusion, erythema, peripheral edema, diarrhea, gastrointestinal or abdominal pain) and infections (including respiratory tract or lung infections, wound inflammation or infection, and extrasurgical-site infections), in patients with a BMI of 40 kg/m 2 or greater compared with patients with a BMI less than 40 kg/m 2 . Conclusions After THA or TKA, morbid obesity is not associated with an increased risk of VTE or bleeding but is associated with increased early postoperative complications, including erythema, peripheral edema, diarrhea and gastrointestinal or abdominal pain, wound inflammation or infection, extrasurgical-site infections, and respiratory tract or lung infections.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Friedman¹,

Hess

Berkowitz

et al. 2013

Clinical Orthopaedics &Amp; Related Research

166

View full text Add to dashboard Cite

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“…Additionally, the impact of various risk factors is cumulative (21,22). Therefore, it is imperative to identify the risk factors and address them preoperatively to reduce the risk of PJI and other postoperative complications.…”

Section: Prevention Of Pjimentioning

confidence: 99%

“…An American Society of Anesthesiologists score of greater than 2, uncontrolled diabetes, and rheumatoid arthritis, for example, can significantly increase the risk of PJI (18,20,(23)(24)(25). Furthermore, any other comorbidity accompanied by diabetes is shown to place patients at a cumulatively higher risk for infection (21,26).…”

Section: Medical Optimization Of Hostmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection

Rezapoor

Parvızı

2015

The Journal of Arthroplasty

119

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“…However, morbid obesity is associated with a higher risk of postoperative complications [6,21,24]. In addition, super obesity (BMI C 50 kg/m 2 ) has been reported to pose an even more substantial risk compared with the risk in patients who are less obese (BMI \ 50 kg/m 2 ) [8,15,23]. However, few peer-reviewed studies have addressed the surgical dilemma regarding whether to perform THA on patients who are morbidly obese or super obese [2,6,16,23].…”

Section: Introductionmentioning

confidence: 99%

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Meller¹,

Toossi

Gonzalez

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patients with morbid obesity, defined as a BMI greater than 40 kg/m 2 , and super obesity, defined as a BMI greater than 50 kg/m 2 , increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m 2 to delineate risks, complications, and costs for these patients. Questions/purposes We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI C 40 kg/m 2 ) or super obese (BMI C 50 kg/m 2 ). Methods This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This study was performed via electronic collaboration at the authors' institutions. (HR, 3.91; 95% CI, 3.14-4.86; p \ 0.001). In addition, patients with morbid obesity had increased risk of deep vein thrombosis (HR, 1.43; 95% CI, 1.14-1.79; p \ 0.002), pulmonary embolism (HR, 1.57; 95% CI, 1.25-1.99; p \ 0.001), implant failure (HR, 1.48; 95% CI, 1.3-1.68; p \ 0.001), acute ...

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Morbidly Obese, Diabetic, Younger, and Unilateral Joint Arthroplasty Patients Have Elevated Total Joint Arthroplasty Infection Rates

Cited by 328 publications

References 24 publications

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Complication Rates After Hip or Knee Arthroplasty in Morbidly Obese Patients

Prevention of Periprosthetic Joint Infection

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

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