The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

Abstract

Overweight represents a major issue in contemporary orthopaedic practice. A higher body mass index (BMI) is associated with an increase of perioperative complications following several orthopaedic procedures, in particular total hip arthroplasty (THA). However, the influence of overweight on THA surgical time is controversial. In this study, we investigated the association between BMI and surgical time analyzing the role of patients’ comorbidities. We conducted a retrospective study on 748 patients undergoing THA at our institutions between 2017 and 2018. Information regarding medical diseases was investigated and the burden of comorbidity was quantified using the Charlson score (CCI). Surgical time and blood loss were also recorded. Median surgical time was 76.5 min. Patients with surgical time above the median had both a higher BMI (28.3 vs. 27.1 kg/m2; p = 0.002); and CCI (1 vs. 0; p = 0.016). According to linear regression, surgical time was associated with BMI in the unadjusted model (p < 0.0001), after adjusting for age and sex (p < 0.0001), and in the multivariable model (p = 0.005). Furthermore, BMI was associated with increased surgical time only in patients with a Charlson score above the median, but not in others. Obesity is associated with increased surgical time during THA, especially in pluricomorbid patients, with a higher risk of perioperative complications.

The impact of body mass index on oncoplastic breast surgery: A multicenter analysis

“…Obese patients tended to have longer Total Operating Room Times (TORT) and Surgical Operating Room Times (SORT), with no decrease in surgical efficacy 25–27 . This finding has been particularly well documented and should be taken into consideration when scheduling breast procedures 28,29 . Increased operative time may be due to general factors such as positioning, induction, and intubation, or technical challenges during surgery, such as more tissue to dissect and suture.…”

“…[25][26][27] This finding has been particularly well documented and should be taken into consideration when scheduling breast procedures. 28,29 Increased operative time may be due to general factors such as positioning, induction, and intubation, or technical challenges during surgery, such as more tissue to dissect and suture. This has significant financial implications, as average operating costs have increased from $20/min in 1991 to $46/min in 2022.…”

Unstable Total Hip Arthroplasty: Should It Be Revised Using Dual Mobility Implants? A Retrospective Analysis from the R.I.P.O. Registry

“…The tendency in the literature and the findings in our study seem to emphasize the use of DMC in the elderly population, also highlighting that revisions are much more common in this age group. Several studies showed that obesity could be related to increased peri operative complications [ 24 , 25 ] and risk of failure because of the mechanical stress applied on the implant surfaces [ 26 ]. Unexpectedly, our results did not show differences between groups, and this can be interpreted from the limited cohort of patients when divided for BMI.…”

Perioperative safety assessment of patients undergoing unilateral or bilateral hip replacements

“…Studies have not demonstrated statistical perioperative complication rate differences in patients undergoing TKRs or THRs across BMI categories ( 25 ). One retrospective study showed that overweight patients undergoing primary THR have a higher risk of increased surgical time and intraoperative blood loss, particularly if they present with multiple comorbidities ( 26 ). A recent study showed that obesity could increase perioperative blood loss but did not increase transfusion risk for patients undergoing simultaneous bilateral THRs.…”