Bariatric Surgery Prior to Total Knee Arthroplasty is Associated With Fewer Postoperative Complications
Section snippets
Materials and Methods
All data were derived from a publicly available database of patients, the PearlDiver Patient Records Database (www.pearldiverinc.com; PearlDiver Inc, Fort Wayne, Indiana). The database contains procedure volumes, demographics, and average charge information for patients with International Classification of Diseases, 9th Revision (ICD-9) diagnoses and procedures or Current Procedural Terminology (CPT) codes. Data for the present study were derived from the Medicare database within the PearlDiver
Results
A total of 78,036 unique patients who underwent TKA were identified from 2005 to 2011, including 66,523 non-obese patients, 11,294 morbidly obese patients who did not undergo bariatric surgery and 219 morbidly patients who underwent bariatric surgery for weight loss prior to TKA. Of the 219 patients who underwent bariatric surgery prior to TKA, 70 had their TKA within 1 year of bariatric surgery, 59 underwent TKA between 1 and 2 years after bariatric surgery and 90 underwent TKA more than 2 years
Discussion
Obesity has been demonstrated to increase the risk of postoperative complications after total knee arthroplasty in numerous previous studies 24., 26., 42., 43., 44., 31., 45., 46.. While bariatric surgery has emerged as an option for weight loss and comorbidity control in morbidly obese patients, existing literature regarding such procedures prior to total knee arthroplasty have failed to demonstrate a significant reduction in postoperative complications 38., 39., 40., 41.. The present national
Conclusions
Obesity and its associated medical comorbidities place patients undergoing TKA at a significantly increased risk for both major and minor postoperative complications. Previous studies have failed to demonstrate a significant reduction in postoperative TKA complication rates with preoperative bariatric surgery, likely due to low patient numbers. The present study demonstrates that bariatric surgery prior to TKA appears to be associated with less risk of postoperative complications, although not
References (48)
- et al.
The epidemiology of obesity
Gastroenterol Clin North Am
(2010) - et al.
Relationship of physical fitness vs body mass index with coronary artery disease and cardiovascular events in women
JAMA
(2004) - et al.
Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland
Hypertension
(2004) - et al.
National obesity trends in total knee arthroplasty
J Arthroplasty
(2013) - et al.
The obesity epidemic: its effect on total joint arthroplasty
J Arthroplasty
(2007) - et al.
Obesity and perioperative morbidity in total hip and total knee arthroplasty patients
J Arthroplasty
(2005) - et al.
Prevalence and trends in obesity among US adults, 1999–2008
JAMA
(2010) Health, United States, 2013: With Special Feature on Prescription Drugs
(2014)- et al.
The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis
BMC Public Health
(2009) - et al.
Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2
Am J Epidemiol
(2006)
Obesity
Lancet
Obesity and its comorbid conditions
Clin Cornerstone
Changes in body weight and body fat distribution as risk factors for clinical diabetes in US men
Am J Epidemiol
Obesity in older adults: a systematic review of the evidence for diagnosis and treatment
Obesity (Silver Spring)
Comorbidities of overweight and obesity: current evidence and research issues
Med Sci Sports Exerc
Abdominal adiposity and coronary heart disease in women
JAMA
Associations of general and abdominal obesity with multiple health outcomes in older women: the Iowa Women's Health Study
Arch Intern Med
Body mass index, waist circumference, and health risk: evidence in support of current National Institutes of Health guidelines
Arch Intern Med
Hyperinsulinemia, dyslipidemia, and obesity as risk factors for hospitalized gallbladder disease. A prospective study
Ann Epidemiol
Prospective study of body mass index and risk of stroke in apparently healthy women
Circulation
A prospective study of body mass index, weight change, and risk of stroke in women
JAMA
Discrimination of health risk by combined body mass index and waist circumference
Obes Res
Obesity, knee osteoarthritis and knee arthroplasty: a review
BMC Sports Sci Med Rehabil
Osteoarthritis: an update with relevance for clinical practice
Lancet
Cited by (73)
Go Big or Go Home: Obesity and Total Joint Arthroplasty
2023, Journal of ArthroplastyBariatric surgery prior to elective shoulder arthroplasty: a Nationwide Inpatient Sample analysis
2023, Seminars in Arthroplasty JSESAn Update on the Management and Optimization of the Patient with Morbid Obesity Undergoing Hip or Knee Arthroplasty
2023, Orthopedic Clinics of North AmericaClinical Outcomes of Bariatric Surgery Before Spinal Fusion: A Systematic Review
2023, World Neurosurgery
One ormore of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2014.11.039.