Abstract
Introduction
Previous research has indicated that preoperative modification of risk factors associated with obesity may reduce complications after TKA. However, the optimal method is still debated. This study aims to investigate whether a preoperative Risk Stratification Tool (RST) devised by our institution to optimize obese patients can reduce unexpected ICU transfers, and 90-day ED visits, readmissions, and reoperations.
Methods
We retrospectively reviewed 1,724 consecutive risk stratified patients undergoing primary unilateral TKA. The mean age was 64.8 years and average body mass index (BMI) was 34.2 kg/m2. All patients underwent preoperative optimization using the RST. We first compared our primary variables of interest between obese (BMI>30, n=1,189) and non-obese patients (n=535). Patients were then divided into 3 groups (I-non-obese, II-obese (30–39.9 kg/m2) and III-morbidly obese ((>40 kg/m2)) and logistic regression was used to evaluate outcomes among the groups adjusted for age, sex, smoking history and diabetes.
Results
Overall, obese patients had an increased rate of discharge to facility compared to non-obese patients (38.0% vs 25.9%, p<0.001). After stratifying by BMI (group I (n=535), II (n=793), III (n=396)), discharge to facility remained higher relative to non-obese (25.9%) in both obese (34.0%, OR 1.6, CI 1.3–2.1) and morbidly obese (45.8%, OR 3.0, CI 2.2–4.1) patients. However, there was no difference in unexpected ICU transfer (0.6% non-obese vs 1.0% obese [OR 1.9, CI 0.5–7.3] vs 1.8% morbidly obese [OR 4.1, CI 1.0–17.2]), ED visits (8.6% vs 10.5% [OR 1.3, CI 0.9–1.9] vs 10.3% [OR 1.2, CI 0.7–1.9]), readmissions (4.7% vs 4.3% [OR 1.0, CI 0.6–1.8] vs 4.8% [OR 1.3, CI 0.7–2.6]), or reoperations (2.4% vs 3.3% [OR 1.3, CI 0.6–2.5] vs 3.0% [OR 1.0, CI 0.7–2.2]).
Conclusion
Use of a preoperative risk stratification tool is effective at lowering the risk of short-term complications after TKA in obese patients to similar levels as non-obese patients.
For any figures or tables, please contact the authors directly.
