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Lower complication rates with bariatric surgery prior to TKA, but not equal to non-obese rates

Issue: December 2014

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DALLAS — A database study presented here showed patients who underwent bariatric surgery for weight loss prior total knee arthroplasty had significantly lower rates of major and minor 90-day postoperative complications compared with morbidly obese patients who did not undergo bariatric surgery.

However, total knee arthroplasty (TKA) patients who had prior bariatric surgery still had significantly higher 90-day major, minor and medical complication rates compared to non-obese TKA patients.

“Morbid obesity and its related medical comorbidities are associated with significant increases in postoperative complications after total knee arthroplasty,” Brian C. Werner, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting. “Previous studies have failed to demonstrate a significant reduction in complications with bariatric surgery. However, the present study demonstrates that bariatric surgery prior to TKA appears to be associated with less risk of complications, but not to the same level of non-obese patients.”

Brian C. Werner

Werner and his colleagues used the PearlDiver database to evaluate the association between preoperative bariatric surgery for weight loss and complication rates after total knee arthroplasty (TKA). The researchers identified 66,523 non-obese TKA patients, 11,294 patients who were morbidly obese (body mass index greater than 40) and did not undergo bariatric surgery prior to TKA, and 219 patients who had bariatric surgery for weight loss prior to TKA.

A comparison of 90-day postoperative complications between the bariatric surgery and morbidly obese groups showed the bariatric surgery groups had significantly lower rates of major complications (9.6% vs. 19%) and minor complications (15.1% vs. 22.6%).

“Infection was also lower in the patients who had bariatric surgery and the medical complications were also lower,” Werner said with rates of 1.8% vs. 5% and 14.2% vs. 26.4%, respectively.

A comparison of patients who underwent bariatric surgery with the non-obese control group did not show similar 90-day complication rates. Major, minor, infection and medical complication rates for non-obese patients were 6.1%, 8.3%, 1.2% and 8.9%, respectively.

“The major complication rate, minor complication rate and medical complication rate were still statically significantly higher in the patients who had bariatric surgery compared with the non-obese patients. However, the infection rates were similar between the two groups,” Werner said.  — by Gina Brockenbrough, MA

Werner BC. Paper #1. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-9, 2014. Dallas.