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Greater BMI strongly associated with risk of revision shoulder surgery, postoperative complications
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Patients who underwent shoulder arthroplasty and had a higher BMI had a strong association with increased rates of revision surgical procedures and postoperative complications, according to results.
Eric R. Wagner, MD, and colleagues identified 4,567 consecutive shoulder arthroplasty cases (55% were women) from 1970 to 2013 through an institutional total joint registry. Overall, 36% of patients had a BMI of 30 kg/m2 to 40 kg/m2 and 7% of patients had a BMI of greater than 40 kg/m2, yielding a mean BMI of 29.7 kg/m2.
Results showed a link between increasing BMI and increased risks of a revision surgical procedure, reoperation, revision for mechanical failure and superficial infections. However, researchers found a negative correlation between increasing BMI and the risk of a periprosthetic fracture. As BMI increased, the risk of revision surgical procedure increased in a linear fashion. Researchers also found an association between increased BMI and an increased risk of revision for mechanical failure.
Multivariate model results showed a significant link between BMI and risk of a revision for any reason, revision for mechanical failure and reoperation. Researchers found the link between increasing BMI and superficial wound infection was the most marked correlation between increasing BMI and any complication in shoulder arthroplasty.
“As patients’ BMI increased, their risk for many complications after shoulder arthroplasty increased in a linear fashion,” Wagner told Healio.com/Orthopedics. “We hope this data will be utilized by physicians, orthopedic surgeons and patients to make informed decisions concerning the relative risks and benefits of elective shoulder arthroplasty, as well as lay a framework for potential future studies into the efficacy of collaborative efforts between care providers to modify these preoperative risk factors. Finally, as the health care delivery model evolves, we hope this and other similar studies will influence preoperative risk stratification, incentivizing surgeons to take care of more complex patients with higher risks of postoperative complications, such as morbidly obese patients.” – by Casey Tingle
Disclosures: Wagner reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Michael L. Pearl, MD
Every shoulder surgeon knows how much more difficult shoulder arthroplasty can be on an obese patient. The deltopectoral interval is of finite length and the deeper it gets, the more difficult it is to see and position retractors for accurate placement of instruments and implants. Extending the arm for resection of the humeral head and reaming the canal becomes increasingly difficult with increasing body habitus. Furthermore, these patients often have mobility issues compromising their ability to limit the use of their arm in the postoperative setting. Understandably, their complication rates are higher as documented in this study.
The dilemma for these patients and their surgeons is the pain and poor function from their arthritis makes it harder for them to stay mobile and exercise, further perpetuating their obesity. As this study points out, increasing BMI is a trend that we can expect to continue, and we learn to be especially vigilant when the BMI is equal to or greater than 35 kg/m2. The information provided in this study and more like it will help surgeons better advise their patients and manage these challenging cases more effectively.
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