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Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight
Afshin A Anoushiravani1, Zain Sayeed2, Monique C Chambers3
1Albany Medical College, Albany, New York.
Insights
Patients with low body mass index (BMI) undergoing hip or knee replacement surgery face increased risks of complications and higher healthcare costs. Understanding these outcomes can help optimize treatment for diverse patient groups.
Area of Science:
- Orthopedic Surgery
- Nutritional Science
- Health Services Research
Background:
- Poor nutritional status, often indicated by low body mass index (BMI), is a significant and preventable factor impacting patient health.
- A low BMI (≤19 kg/m(2)) is frequently associated with adverse health outcomes, necessitating further investigation in surgical contexts.
Purpose of the Study:
- To conduct a comparative analysis of patients with low (≤19 kg/m(2)) versus normal (19-24.9 kg/m(2)) BMI undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- To determine the correlation between BMI, postoperative outcomes, and resource utilization in orthopedic surgery patients.
Main Methods:
- Utilized discharge data from the National Inpatient Sample (2006-2012) for 3550 THA and 1315 TKA patients.
- Divided patients into underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)) cohorts, matched for 27 comorbidities using the Elixhauser Comorbidity Index.
- Analyzed in-hospital postoperative outcomes and resource utilization using multivariate analyses and chi-squared tests (P < .05).
Main Results:
- Underweight THA patients exhibited higher risks of postoperative anemia and cardiac complications, alongside decreased infection risk.
- Underweight TKA patients showed increased risks of hematoma/seroma and postoperative anemia.
- Both underweight THA and TKA cohorts experienced longer hospital stays, higher hospital charges, and increased likelihood of discharge to skilled nursing facilities.
Conclusions:
- Low BMI is associated with a greater likelihood of postoperative complications and increased resource utilization in THA and TKA.
- These findings aid orthopedic surgeons in predicting patient outcomes and refining treatment strategies for diverse patient demographics.
Background:
Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists.
Methods:
Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05.
Results:
Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities.
Conclusion:
Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.
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