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Bariatric surgery linked with reduced comorbidity burden in obese patients scheduled for TJA
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DALLAS — Bariatric surgery prior to total joint arthroplasty in morbidly obese patients was associated with reduced preoperative comorbidity burden and complications at the time of arthroplasty, according to a speaker here.
“We all know that there is an obesity epidemic in the United States,” Ashley E. Levack, MD, MAS, said at the American Association of Hip and Knee Surgeons Annual Meeting. “Younger and heavier patients are requiring total joint arthroplasty [TJA], and these patients have a high comorbidity burden and a high complication rate, especially if their BMI is greater than 40. However, obesity is a potentially modifiable risk factor preoperative[ly] and can be modified by weight loss.”
Levack and her colleagues matched morbidly obese 2,636 patients undergoing total knee arthroplasty (TKA) who received prior bariatric surgery with 2,636 morbidly obese patients undergoing TKA who did not have the weight loss procedure. They also matched 792 morbidly obese patients undergoing total hip arthroplasty (THA) who received prior bariatric surgery with 792 morbidly obese patients who did not have bariatric surgery. Researchers used propensity scores to match patients, which was defined as the conditional probability of receiving bariatric surgery, age, year TJA was performed, laterality, sex, payer, region and Elixhauser comorbidities.
“Bariatric surgery is the most-effective, durable treatment for weight loss in this subset of patients. Not only does it decrease excessively, it decreased the comorbidity burden, increases life expectancy and increases quality of life,” Levack said.
Results showed bariatric surgery lowered the comorbidity burden prior to TJA, lowered hospital complications in all patients and lowered 90-day complications in patients undergoing TKA.
No differences in revision risks and THA dislocation were found.
[Some of the limitations are that the study] is limited to the New York population subject to patients living in and out of the state, as well as patients seeking care elsewhere,” Levack said. – by Nhu Te
Reference:
Levack A, et al. Paper #44. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 10-13, 2016; Dallas.
Disclosure: Levack reports no relevant financial disclosures.