The influence of obesity on perioperative morbidity and mortality in revision total hip arthroplasty

Visscher

Clinical Orthopaedics &Amp; Related Research

et al. 2014

118

Background The number of obese patients undergoing THA is increasing. Previous studies have shown that obesity is associated with an increased likelihood of complications after THA, but there is little information regarding the impact of obesity on medical resource use and direct medical costs in THA. Questions/purposes We sought to examine the relationship between obesity, length of stay, and direct medical costs in a large cohort of patients undergoing THAs. Methods The study included 8973 patients who had undergone 6410 primary and 2563 revision THAs at a large US medical center between January 1, 2000, and September 31, 2008. Patients with bilateral procedures within 90 days after index admission and patients with acute trauma were excluded. Data regarding clinical, surgical characteristics, and complications were obtained from the original medical records and the institutional joint registry. Patients were classified into eight groups based on their BMI at the time of surgery. Direct medical costs were calculated by using standardized, inflation-adjusted costs for services and procedures billed during hospitalization and the 90-day window. Study end points were hospital length of stay, direct medical costs during hospitalization, and the 90-day window. End points were compared across the eight BMI categories in multivariable risk-adjusted linear regression models. Results Mean length of stay and the direct medical costs were lowest for patients with a BMI of 25 to 35 kg/m 2 . Increasing BMI was associated with longer hospital stays and costs. Every five-unit increase in BMI beyond 30 kg/ m 2 was associated with approximately USD $500 higher hospital costs and USD $900 higher 90-day costs in primary THA (p = 0.0001), which corresponded to 5% higher costs. The cost increase associated with BMI was

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obesity Increases Length of Stay and Direct Medical Costs in Total Hip Arthroplasty

Visscher

Clinical Orthopaedics &Amp; Related Research

et al. 2014

118

Clinical Orthopaedics &Amp; Related Research

“…Patients in between these two values were not included in the study [7]. Another study of 229 patients by Perka et al [13] reported overweight patients had an increased operative time in revision hip surgery but no other increase in perioperative complications. Long-term outcomes were not reported [13].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Isolated Acetabular Revision

Lawless

Healy

Sharma

et al. 2010

Isolated acetabular revision can be associated with variable patient outcomes; there is a risk of hip instability. We evaluated 42 isolated acetabular revision operations and investigated the impact of patient age, diagnosis, bone stock, bone loss, bone augmentation, and obesity on pain and the Harris hip score. Preoperative radiographs were graded according to Paprosky et al. Postoperative radiographs were graded according to Moore et al. and for implant position, prosthetic fixation, and osteolysis. Complications, patient outcome, reoperations, and acetabular rerevisions were recorded. All patients had complete clinical and radiographic followup with a minimum followup of 2 years (mean, 6.4 years; range, 2-13 years). The mean pain score and the mean Harris hip score improved postoperatively. There was one infection 6 months after operation. There were no dislocations. There were three acetabular rerevisions (7%) for aseptic loosening. Patient age, preoperative diagnosis, bone loss, and pelvic bone augmentation had no influence on pain or Harris hip scores. Before operation, obese patients tended to have less pain than nonobese patients but at followup obese patients had less improvement in pain scores than nonobese patients.

Differences in outcomes of obese women and men undergoing primary total hip arthroplasty

Lübbeke

Stern

Garavaglia

et al. 2007

Arthritis & Rheumatism

138

Objective. To evaluate the effect of obesity on the incidence of main complications (infection, dislocation, and revision), functional outcome, and patient satisfaction 5 years after primary total hip arthroplasty (THA), and to determine whether results differ between obese women and men. Methods. We conducted a hospital-based prospective cohort study including patients who underwent primary THA (2,495 hips) between 1996 and 2005. We used rates and rate ratios to compare the incidence of main complications in obese and nonobese patients, and we stratified the data for sex. Functional outcome was measured using the Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index. Results. The adjusted incidence rate ratio for infection (obese versus nonobese) was 4.4 (95% confidence interval [95% CI] 1.8, 10.8). Obesity substantially increased the infection rate in women (incidence rate ratio comparing obese with nonobese women 16.1; 95% CI 3.4, 75.7), whereas obesity appeared to have no effect in men (incidence rate ratio 1.0; 95% CI 0.2, 5.3). The adjusted incidence rate ratio for dislocation (obese versus nonobese) was 2.4 (95% CI 1.4, 4.2), with a higher rate increase in obese women. A total of 817 patients had a 5-year clinical followup visit. Functional outcome and satisfaction were slightly lower in obese women partly due to higher complication rates. No difference was seen in men. Conclusion. Primary THA is a successful intervention in obese patients, but physician and patient must be aware of increased complications, particularly in women.