Elsevier

The Journal of Arthroplasty

Volume 33, Issue 7, July 2018, Pages 2287-2292.e1
The Journal of Arthroplasty

Complications - Other
Obesity Increases the Risk of Postoperative Complications and Revision Rates Following Primary Total Hip Arthroplasty: An Analysis of 131,576 Total Hip Arthroplasty Cases

https://doi.org/10.1016/j.arth.2018.02.036Get rights and content

Abstract

Background

The aim of our study is to evaluate the association of body mass index (BMI) and the risk of postoperative complications, mortality, and revision rates following primary total hip arthroplasty given other potentially confounding patient characteristics in a large cohort study.

Methods

Using nationwide billing data for inpatient hospital treatment of the biggest German healthcare insurance, 131,576 total hip arthroplasties in 124,368 patients between January 2012 and December 2014 were included. Outcomes were 90-day mortality, 1-year revision procedures (with and without removal or exchange of implants), 90-day surgical complications, 90-day femoral fractures, and overall complications. The effect of BMI on outcome was analyzed using multivariable logistic regression. Risk-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.

Results

BMI had a significant effect on overall complications (30-34 in kg/m2: OR 1.1, CI 1.0-1.2, P = .014; 35-39: OR 1.5, CI 1.3-1.6, P < .001; ≥40: OR 2.1, CI 1.9-2.3, P < .001; <30: reference). The OR for 1-year revision procedures (30-34: OR 1.2, CI 1.1-1.4, P = .001; 35-39: OR 1.6, CI 1.4-1.8, P < .001; ≥40: OR 2.4, CI 2.1-2.7, P < .001; <30: reference) and 90-day surgical complications increased with every BMI category. For mortality and periprosthetic fractures there was a higher risk only for patients with BMI ≥40.

Conclusion

BMI increases the risk of revision rates in a liner trend. Therefore, the authors believe that patients with a BMI >40 kg/m2 should be sent to obesity medicine physicians in order to decrease the body weight prior elective surgery.

Section snippets

Database Characteristics

Data were collected from the German healthcare insurance Allgemeine Ortskrankenkasse (AOK). The AOK provides nationwide healthcare insurance for approximately 30% of the German population [19] and is the largest provider of statutory healthcare insurance in Germany. Everyone is allowed to enroll in the AOK regardless of factors such as age, pre-existing comorbidities, income, or type of employment. Anonymized nationwide administrative claims data were analyzed for inpatient episodes (including

Study Population

During the study period (2012-2014), a total of 131,576 THAs in 124,368 patients were included. The median age was 72 years (interquartile range 62-77). Female patients accounted for 60.5% of the cases. Table 1 provides a detailed overview of patient characteristics. Obesity, defined as BMI >30 kg/m2, was documented in 15.9% of the cases. The distribution of age across BMI categories is shown in Figure 1. The proportion of female patients increased with increasing BMI (<30 kg/m2: 60.3%; ≥40 kg/m

Discussion

The most important finding of this study is that obesity increases the risk for all types of complications and revision rates in patients undergoing primary THA. Notably, those patients with a BMI ≥40 kg/m2, that is, morbidly obese, had a 3-fold increased risk of deep infection and a 2-fold increased risk of any complication compared to patients with a BMI <30 kg/m2. For overall complications, 1-year revision surgery, and 90-day surgical complications the risk increased with every BMI category

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    One or more 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 https://doi.org/10.1016/j.arth.2018.02.036.

    Compliance with Ethical Standards.

    Independent from the submitted manuscript, received royalties/payments of all authors are listed below:

    • Waldemar Link - Hamburg, Germany

    • Zimmer, Warsaw, Indiana

    • Fresenius Helios, Germany

    • Smith and Nephew, United Kingdom

    • ImplanTec Deutschland GmbH, Germany

    Funding: There is no funding source.

    Ethical approval: This study is based on data provided by hospitals for health insurance accounting. The recommendations for good practice in secondary data analysis developed by the German Working Group on the Collection and Use of Secondary Data were applied in full. Therefore, no formal ethical committee approval was needed.

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