Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels

Mar 13, 2018The Journal of arthroplasty

Ninety-Day Costs, Repeat Surgeries, and Hospital Returns After First Knee Replacement in Patients with Different Body Weights

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Abstract

90-day costs for super-obese patients undergoing total knee arthroplasty averaged $14,021, significantly higher than for non-obese and overweight cohorts.

Morbidly obese patients incurred average costs of $11,568, also greater than smaller BMI cohorts.
Increased costs were primarily associated with higher readmission rates.
Change scores for Knee Society Scores, SF-12 Mental Health Composite Score, and Western Ontario and McMaster Universities Arthritis Index were similar across all BMI cohorts.
No significant differences in repeat surgery or aseptic revision rates were observed at midterm follow-up.
The super-obese cohort experienced a higher rate of septic revisions (6.2%) compared to other cohorts (0.8-3.1%).

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BACKGROUND: We compared 90-day costs and outcomes for primary total knee arthroplasty patients among nonobese (body mass index [BMI] 18.5-24.9), overweight (25-29.9), obese (30-34.9), severely obese (35-39.9), morbidly obese (40-49.9), and super-obese (50+) cohorts.

METHODS: We conducted a retrospective review of an institutional database of total knee arthroplasty patients from 2006 to 2013 with a minimum of 3-year follow-up. Sixty-five super-obese patients were identified, and five other cohorts were randomly selected in a 2:1 ratio (total, n = 715). Demographics, 90-day outcomes (costs, reoperations, and readmissions), and outcomes after 3 years (revisions and change scores for Short-Form Health Survey [SF-12], Knee Society Scores, and Western Ontario and McMaster Universities Arthritis Index) were aggregated.

RESULTS: The 90-day costs were significantly greater in the morbidly obese ($11,568 ± $1,960) and super-obese ($14,021 ± $7,903) cohorts relative to the smaller BMI cohorts ($9,938 - $10,352). The increased cost from readmissions was the main driver of costs. The outcome change scores were similar across all the BMI cohorts for Knee Society Scores, SF-12 Mental Health Composite Score, and Western Ontario and McMaster Universities Arthritis Index, but not for the SF-12 Physical Health Composite Score. At the midterm follow-up, there was no statistical difference in repeat surgery or aseptic revision rates. Septic revisions were significantly greater in the super-obese cohort relative to the other cohorts (6.2% vs 0.8-3.1%).

CONCLUSION: Health-care policy based purely on the economic costs may place morbidly obese and super-obese patients at risk of losing arthroplasty care, thereby denying them access to the comparable quality of life improvements.

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Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels

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