Complications - OtherObesity Increases the Risk of Postoperative Complications and Revision Rates Following Primary Total Hip Arthroplasty: An Analysis of 131,576 Total Hip Arthroplasty Cases
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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Cited by (51)
Intermuscular Fat, But Not Subcutaneous Fat, Correlated With Major Complications After Primary Total Hip Arthroplasty
2023, Academic RadiologyCitation Excerpt :Finding possible risk factors for major complications after THA is of great significance for orthopedists to reduce the incidence of major complications. Obesity, commonly measured by body mass index (BMI), has been widely investigated to be an important risk factor for complications after THA (5–8). There was a positive association between increased BMI and postoperative complications.
Functional recovery after total hip/knee replacement in obese people: A systematic review
2023, Annals of Physical and Rehabilitation MedicineCitation Excerpt :It is worth noting that this meta-analysis, like many others [10,11], underscores the negative effects of obesity on other intra- and post-operative data. Thus, despite a mortality rate in the obese groups that is equivalent to, or even lower, in some articles [45–47] and, although the literature as a whole agrees that there are significantly more non-fatal complications associated with THR and TKR, it is difficult to make an operative decision for people with obesity. The decision to operate should be made on a case-by-case basis, with clear information for the person in light of current data.
What Is the Impact of Body Mass Index Cutoffs on Total Hip Arthroplasty Complications?
2022, Journal of ArthroplastyFailure to Medically Optimize Before Total Hip Arthroplasty: Which Modifiable Risk Factor Is the Most Dangerous?
2021, Arthroplasty TodayCitation Excerpt :Although not all risk factors are modifiable, certain ones are. There is mounting evidence that smoking, [1–4] abnormal body mass index (BMI), [11,26–43] uncontrolled diabetes, [44–53] and poor nutritional status [54–57] are associated with poorer THA outcomes. There are also some data to suggest that improving these risk factors is possible before THA and decreases complications [57–67].
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:
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Waldemar Link - Hamburg, Germany
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Zimmer, Warsaw, Indiana
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Fresenius Helios, Germany
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Smith and Nephew, United Kingdom
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ImplanTec Deutschland GmbH, Germany
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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.