Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients

Apr 16, 2016The Journal of arthroplasty

Hospital outcomes and resource use after joint replacement in underweight versus very obese patients

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Abstract

Underweight patients undergoing total joint arthroplasty may incur significantly higher hospital costs and complications compared to morbidly obese patients.

Underweight patients showed a higher risk for developing postoperative anemia, with an odds ratio of 3.1 for total knee arthroplasty (TKA) and 1.8 for total hip arthroplasty (THA).
Underweight THA candidates had a greater risk for deep venous thrombosis, with 75.36% of cases observed in this group compared to 24.64% in morbidly obese patients.
Total hospital charges for underweight TKA patients were higher at USD 51,368.90 compared to USD 40,128.80 for morbidly obese patients, with a statistically significant difference.
Total hospital charges for underweight THA patients were also higher at USD 57,451.8 compared to USD 42,776.9 for morbidly obese patients, with a significant P value.
Length of stay was longer for underweight THA patients, averaging 4.6 days versus 3.5 days for morbidly obese patients.

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BACKGROUND: As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)).

METHODS: Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05.

RESULTS: Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts.

CONCLUSION: Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.

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Comparing In-Hospital Total Joint Arthroplasty Outcomes and Resource Consumption Among Underweight and Morbidly Obese Patients

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