Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty

Werner, Brian C.; Higgins, Matthew D.; Pehlivan, Hakan; Carothers, Joshua T.; Browne, James A.

doi:10.1016/j.arth.2016.08.001

Cited by 78 publications

(37 citation statements)

References 18 publications

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“…Although several studies reported a correlation between increased perioperative blood loss and decreased risk of blood transfusion requirements in THA and TKA, some other studies have reported no significant relationship between BMI, blood loss, and transfusion risk . A number of studies reporting a positive correlation between BMI and transfusion risk did not stratify patient groups using the BMI classification system set forth by the WHO . In this study, higher BMI was associated with decreased risk of ALBT in TKA but not THA.…”

Section: Discussioncontrasting

confidence: 62%

“…[24][25][26][27] A number of studies reporting a positive correlation between BMI and transfusion risk did not stratify patient groups using the BMI classification system set forth by the WHO. 27,28 In this study, higher BMI was associated with decreased risk of ALBT in TKA but not THA. The generalizability of this finding needs to be evaluated in western populations.…”

Section: Discussionmentioning

confidence: 54%

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Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 54%

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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“…This could be explained by increased vigilance that doctors place on ensuring that VTE prophylaxis is administered for these patients in acute hospital. Guidelines that suggest that obesity has a moderate association with VTE 22,23 may have led to increased use of VTE prophylaxis in this group.…”

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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“…36 Additionally, Werner et al reported that BMI > 50 kg/m 2 predisposed patients to various complications in primary THA procedures, including an increased need for transfusion. 37 They postulated that an extreme BMI increased the likelihood of transfusions due to a larger soft tissue envelope, which can prolong operative times due to technical challenges. 29 The exact relationship between BMI and blood transfusion requirements in total joint arthroplasty procedures is likely a product of multiple factors and therefore remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

Lee

Fassihi

et al. 2020

The Journal of Hip Surgery

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Revision total hip arthroplasty (rTHA) is associated with significant intraoperative blood loss requiring transfusion. Given that blood transfusions increase the risk of numerous complications, efforts should be made to determine which patients are at high risk of transfusion and optimize them appropriately. This study aimed to identify independent risk factors associated with blood transfusion in patients undergoing rTHA for mechanical failure. A multi-institutional surgical registry was queried for all patients who underwent rTHA for mechanical failure from 2005 to 2016. Patients were divided into transfused and nontransfused cohorts and underwent univariate analysis for differences in demographic features, preoperative comorbidities, and operative variables. Multivariate regression models were generated to elucidate independent risk factors associated with perioperative blood transfusions. A total of 8,469 rTHA patients met inclusion and exclusion criteria, of which 1,863 (22.0%) received blood transfusions within 72 hours postoperatively. On multivariate logistic regression analysis, age ≥ 65 years (odds ratio [OR] 1.313; p < 0.001), female gender (OR 1.465; p < 0.001), insulin-dependent diabetes mellitus (OR 1.503; p = 0.003), chronic obstructive pulmonary disease (COPD; OR 1.307; p = 0.030), hypertension (OR 1.359; p < 0.001), hematologic disorders (OR 1.565; p < 0.001), preoperative blood transfusions (OR 3.851; p < 0.001), systemic sepsis (OR 2.277; p = 0.003), functional dependence (OR 1.416; p = 0.003), open wounds/wound infections (OR 2.878; p < 0.001), and operations lasting at least 175 minutes (OR 4.841; p < 0.001) were all significant independent risk factors for blood transfusions. Obesity (body mass index [BMI] ≥ 30 kg/m2; OR 0.818; p = 0.001), smoking history (OR 0.800; p = 0.014), and isolated acetabular component revision (OR 0.730; p < 0.001) were associated with a decreased risk of blood transfusion. Older age, female gender, lower BMI, absence of smoking history, functional dependence, insulin-dependent diabetes mellitus, hypertension, revision of the femoral component, preoperative transfusion, hematologic disorders, sepsis, open wounds/wound infections, COPD, and longer operative time were all independent risk factors for blood transfusions in rTHA performed for mechanical failure. By identifying these risk factors, clinicians can identify and optimize high-risk patients to minimize blood transfusion requirements, thereby reducing the risk of transfusion-associated complications in this patient population.

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Super Obesity Is an Independent Risk Factor for Complications After Primary Total Hip Arthroplasty

Cited by 78 publications

References 18 publications

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

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

Risk Factors for Blood Transfusion in Revision Total Hip Arthroplasty for Mechanical Failure

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