Impact of Obesity on Outcomes of Patients With Hip Osteoarthritis Who Underwent Hip Arthroplasty

Hafeez Shaka, Pius E Ojemolon, Hafeez Shaka, Pius E Ojemolon

Abstract

Background While obesity has been clearly established as a risk factor for osteoarthritis (OA), there is a scarcity of studies comparing outcomes between obese and non-obese patients with hip OA who underwent hip arthroplasty. Methods This study involved adults with hip OA who had hip replacement procedures. Data was sourced from the Nationwide Inpatient Sample (NIS) database for 2016 and 2017. The primary outcome was inpatient mortality. Secondary outcomes included the development of non-ST segment elevation myocardial infarction (NSTEMI), sepsis, post-procedure site infection, pneumonia, acute kidney failure, deep vein thrombosis (DVT), pulmonary embolism, need for transfusion of blood products, complications involving orthopedic devices as well as mean length of hospitalization and mean total hospital charges. Results Obese patients did not have higher odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.65, 95% CI 0.303-1.381, p=0.260), had increased mean length of hospitalization (0.11, 95% CI 0.083-0.134, p<0.001) and higher odds of developing DVT (aOR: 1.62, 95% CI 1.187-2.222, p<0.001), acute kidney failure (aOR: 1.64, 95% CI: 1.488-1.807, p<0.001) and pressure-related injuries (aOR: 1.64, 95% CI 1.081-2.483, p=0.020), compared with non-obese patients. Obese patients were found to have a lower aOR of having NSTEMI (aOR: 0.57, 95% CI 0.332-0.986, p=0.044), and need for blood product transfusion (aOR: 0.80, 95% CI 0.726-0.875, p<0.001). Conclusion Although there is no difference in mortality among obese and non-obese patients who had hip arthroplasty, obese adults have increased odds of morbidity and perioperative complications. Hence, obese adults likely require better perioperative management to decrease the incidence of these complications.

Keywords: hip arthroplasty; obesity; osteoarthritis; surgical outcomes.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2020, Shaka et al.

References

    1. The epidemiology of obesity: a big picture. Hruby A, Hu FB. Pharmacoeconomics. 2015;33:673–689.
    1. Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Chen D, Shen J, Zhao W, Wang T, Han L, Hamilton JL, Im HJ. Bone Res. 2017;5:16044.
    1. Epidemiology and burden of osteoarthritis. Litwic A, Edwards MH, Dennison EM, Cooper C. Br Med Bull. 2013;105:185–199.
    1. Osteoarthritis. Hunter DJ, Bierma-Zeinstra S. Lancet. 2019;393:1745–1759.
    1. Varacallo M, Luo TD, Johanson NA. Treasure Island, FL: StatPearls Publishing; 2020. Total Hip Arthroplasty (THA) Techniques.
    1. Impact of diabetes mellitus on outcomes of patients with knee osteoarthritis who underwent knee arthroplasty: an analysis of the nationwide inpatient sample. Ojemolon PE, Shaka H, Edigin E, et al. Cureus. 2020;12:0.
    1. The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study. Cross M, Smith E, Hoy D, et al. Ann Rheum Dis. 2014;73:1323–1330.
    1. The pathophysiology of osteoarthritis. Ashkavand Z, Malekinejad H, Vishwanath BS. J Pharm Res. 2013;7:132–138.
    1. Aging-related inflammation in osteoarthritis. Greene MA, Loeser RF. Osteoarthritis Cartilage. 2015;23:1966–1971.
    1. Hip osteoarthritis: etiopathogenesis and implications for management. Murphy NJ, Eyles JP, Hunter DJ. Adv Ther. 2016;33:1921–1946.
    1. Healthcare Cost and Utilization Project - HCUP. Introduction to the HCUP National Inpatient Sample (NIS) [May;2020 ]; 2018
    1. Houchens R, Ross D, Elixhauser A, Jiang J. HCUP Methods Series Report # 2014-04 . Vol. 4. Rockville, MD: Agency for Healthcare Research and Quality; 2014. HCUP Methods Series: Nationwide Inpatient Sample (NIS) Redesign Final Report - Report #2014-04.
    1. Prevalence of obesity and severe obesity among adults: United States, 2017-2018. Hales CM, Carroll MD, Fryar CD, Ogden CL. NCHS Data Brief. 2020;360:1–8.
    1. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Bliddal H, Leeds A, Christensen R. Obes Rev. 2014;15:578–586.
    1. An update on the treatment of osteoarthritis in obese patients. Deveza L, Hunter D. Expert Opin Pharmacother. 2016;17:753–755.
    1. Is weight loss associated with less progression of changes in knee articular cartilage among obese and overweight patients as assessed with MR imaging over 48 months? Data from the Osteoarthritis Initiative. Gersing AS, Schwaiger BJ, Nevitt MC, et al. Radiology. 2017;284:508–520.
    1. Risk factors and burden of osteoarthritis. Palazzo C, Nguyen C, Lefevre-Colau MM, Rannou F, Poiraudeau S. Ann Phys Rehabil Med. 2016;59:134–138.
    1. Number of persons with symptomatic knee osteoarthritis in the US: impact of race and ethnicity, age, sex, and obesity. Deshpande BR, Katz JN, Solomon DH, et al. Arthritis Care Res. 2016;68:1743–1750.
    1. Factors that affect outcome following total joint arthroplasty: a review of the recent literature. Schwartz FH, Lange J. Curr Rev Musculoskelet Med. 2017;10:346–355.
    1. Ten-year risk of complication and mortality after total hip arthroplasty in morbidly obese patients: a population study. Tohidi M, Brogly SB, Lajkosz K, Harrison MM, Campbell AR, VanDenKerkhof E, Mann SM. Can J Surg. 2019;62:442–449.
    1. Complications of morbid obesity in total joint arthroplasty: risk stratification based on BMI. Ward DT, Metz LN, Horst PK, Kim HT, Kuo AC. J Arthroplasty. 2015;30:42–46.
    1. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Flegal KM, Kit BK, Orpana H, Graubard BI. JAMA. 2013;309:71–82.
    1. The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. Wallace G, Judge A, Prieto-Alhambra D, de Vries F, Arden N, Cooper C. Osteoarthritis Cartilage. 2014;22:918–927.
    1. The influence of obesity on hip pain, function, and satisfaction 10 years following total hip arthroplasty. Haebich SJ, Mark P, Khan RJK, Fick DP, Brownlie C, Wimhurst JA. J Arthroplasty. 2020;35:818–823.
    1. Obesity in total hip arthroplasty: does it make a difference? Haynes J, Nam D, Barrack RL. Bone Joint J. 2017;99-B:31–36.
    1. Hypoalbuminemia more than morbid obesity is an independent predictor of complications after total hip arthroplasty. Walls JD, Abraham D, Nelson CL, Kamath AF, Elkassabany NM, Liu J. J Arthroplasty. 2015;30:2290–2295.

Source: PubMed

Подписаться