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The effect of body mass index on 30-day complications after total hip arthroplasty

William Scully1, Nicolas S Piuzzi1,2, Nipun Sodhi1

  • 1Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, Ohio, USA.

Hip International : the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
|February 6, 2019
PubMed

Insights

This study found that body mass index (BMI) has a complex relationship with 30-day complications after total hip arthroplasty (THA). The lowest complication rates were observed with a BMI around 28 kg/m², suggesting a continuous BMI analysis is crucial for THA outcomes.

Area of Science:

  • Orthopedic Surgery
  • Public Health
  • Biostatistics

Background:

  • Traditional binary or categorical analysis of body mass index (BMI) in total hip arthroplasty (THA) may obscure outcomes.
  • Evaluating BMI as a continuous variable offers a more nuanced understanding of its impact on THA.
  • This study addresses the limitations of categorical BMI assessments in correlating outcomes.

Purpose of the Study:

  • To continuously correlate body mass index (BMI) with 30-day complications following total hip arthroplasty (THA).
  • To analyze the impact of continuous BMI on readmissions, reoperations, medical, and surgical complications.
  • To assess these outcomes across different weight categories: normal, overweight, obese, and morbidly obese.

Main Methods:

  • Utilized the NSQIP database to identify 93,598 primary THA cases.
  • Extrapolated 30-day complication rates (readmissions, reoperations, medical/surgical) and patient BMI data.
  • Employed univariate, multivariate, and spline regression models, adjusting for demographics and comorbidities, to analyze continuous BMI effects.

Main Results:

  • A J-shaped relationship was observed between BMI and readmission, reoperation, superficial infection, prosthetic joint infection, and sepsis, with optimal outcomes around BMI 28 kg/m².
  • Mortality and transfusion risks showed a reverse J-shaped relationship, decreasing with normal to overweight BMIs and then plateauing.
  • Statistical significance (p < 0.05) was found for most analyzed complications.

Conclusions:

  • Body mass index (BMI) exerts a multifactorial influence on post-THA complications.
  • Treating BMI as a continuous variable enhances the assessment of modifiable risk factors and comorbidities.
  • This approach provides a more comprehensive understanding of BMI's role in THA outcomes.
Abstract

Keywords:
BMITHAcontinuous BMIhip arthroplastyoutcomes

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