Pre-operative and post-operative weight trends of total joint arthroplasty patients and outcomes associated with weight change
Year: 2013
Type: dissertation
Study design: Observational Study
Abstract: Little is known about pre- and post-operative weight changes in patients\nundergoing total joint arthroplasty (TJA). While intra-operative body mass index\n(BMI) is associated with higher risk of surgical site infections (SSI) and readmission\nrates post-TJA no studies evaluate the impact of non-surgical pre-operative weight loss\nand post-operative weight maintenance on risk of these outcomes. This study\ndescribes weight changes of patients undergoing TJA, evaluates characteristics\nassociated with weight patterns one year pre- and post-TJA. Additionally, it evaluates\nwhether pre-operative weight loss (5% change) and maintenance post-operatively is\nassociated with SSI and readmission risk post-surgery. A cohort of primary TJAs (total hip arthroplasty (THA) and total knee\narthroplasty (TKA)) performed between 01/01/2008 and 12/31/2010 was identified using\na Total Joint Replacement Registry (TJRR). Using electronic medical records weight\nfrom one year pre- through one year post-TJA patients were categorized into: gainers\n(increased weight by 5%), losers (decreased by 5%), remained the same (changed of\n<5%). Patients were characterized by gender, age, race, health status, and co-morbidities.\nEndpoints, SSI (deep and superficial) and 90 day readmissions, were ascertained\nprospectively by the TJRR.\nIn 30632 TJAs (10572 THAs and 20060 TKAs) most remained the same weight\nduring the year prior (71.5% THAs and 75.7% TKAs) and year after (64.0% THAs and\n68.5% TKAs) the procedure. Women, younger patients, Blacks, and those with certain\nco-morbidities were more susceptible to weight change pre- and post-TJA. Among\nobese (BMI???30kg/m_) patients (4066 THAs and 10718 TKAs), few (18.0% THAs and\n12.4% TKAs) lost weight prior to TJA or became (6% THA, 3% TKAs) non-obese\n(BMI <30kg/m_). A significant reduction in risk of SSI and readmission in those who\nlost 5% of their body weight prior to their TJA procedure was not observed. In obese\nTHA patients who lose weight pre-operatively and keep it off post-operatively (N=444),\nthe likelihood of deep SSI (odds ratio (OR)=3.77, 95% CI 1.59-8.95) is higher than in\npatients who stayed the same weight. Obese TKA patients who lost weight and kept it\noff post-operatively (N=937) were at a higher likelihood of readmission (OR=1.63,\n95%CI 1.16, 2.28) than those who remained the same weight.
Author: Maria Carolina Secorun Inacio
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W284672870