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Despite risks, orthopedic surgery may offer obese patients improvements in pain, function
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Although patients who are obese have an increased risk of complications after undergoing orthopedic surgical interventions, surgery offers improvements in pain and function, according to a literature review published in the Journal of the American Academy of Orthopaedic Surgeons.
“Obesity can accompany a multitude of comorbidities that can have a significant impact on a patient’s outcome from elective orthopedic surgery,” author William M. Mihalko, MD, PhD, said in a press release about the review. “Although no upper weight limits have been established that would contraindicate elective orthopedic surgery, every surgeon must understand the unique risks an obese patient faces and understand how to optimize and treat each of these patients on an individual basis.”
Patients who are obese are at an increased risk for several medical conditions, such as diabetes, cardiovascular disease, pulmonary disease, metabolic syndrome and obstructive sleep apnea, which could create complications during and after orthopedic surgery.
When undergoing orthopedic surgery, use of a perioperative beta blockade should be considered among patients who are obese and also have a high risk for cardiac events, whereas administration of the STOP BANG test can identify patients who may need supplemental oxygen or a continuous positive airway pressure machine after surgery due to obstructive sleep apnea.
Although complication rates are higher and recovery slower among obese patients after total joint, hip and knee arthroplasty, research has shown more improvement in function; however, a body mass index of 40 has been recommended previously as the cut-off for surgery, and weight loss prior to surgery is strongly recommended, according to the review.
There are no established guidelines on how to treat overweight and obese orthopedic patients; however, Mihalko and colleagues recommend performing a preoperative evaluation, including testing of electrolyte and glucose levels, a complete blood cell count, an electrocardiogram followed by an echocardiogram at signs of congestive heart failure and measurements of renal function.
After surgery, mechanical or pharmacologic prophylaxis are recommended to lower the risk for venous thromboembolism and pulmonary embolism.
Disclosure: See the study for a full list of all authors’ relevant financial disclosures.
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