Justification of Body Mass Index cutoffs for hip and knee joint arthroplasty among California orthopedic surgeons
Sophie V Orr1, Gavin C Pereira1, Blaine A Christiansen2
1Department of Orthopaedic Surgery, Lawrence J. Ellison Musculoskeletal Research Center, University of California Davis Health, 2700 Stockton Blvd, Suite 2301, Sacramento, CA, 95817, USA.
Insights
Many orthopedic surgeons deny joint replacement surgery to patients with a high Body Mass Index (BMI). Addressing surgeon-specific BMI cutoffs can improve access to essential orthopedic care and reduce healthcare disparities.
Area of Science:
- Orthopaedic Surgery
- Obesity Medicine
- Healthcare Access
Background:
- Many orthopedic surgeons avoid joint arthroplasty for patients with a Body Mass Index (BMI) ≥ 35 due to perceived risks and poorer outcomes.
- Identifying surgeon-specific BMI cutoffs is crucial for improving access to care for obese patients and reducing healthcare disparities.
- Addressing these factors can highlight areas for improvement in facilities, equipment, and procedures for accommodating larger individuals.
Purpose of the Study:
- To identify surgeon-specific Body Mass Index (BMI) cutoffs for hip and knee arthroplasty.
- To understand the justifications surgeons use for setting these BMI cutoffs.
- To inform strategies for increasing access to joint replacement surgery for patients with higher BMIs.
Main Methods:
- A survey was distributed to orthopedic surgeons via the California Orthopaedic Association (COA) report in March 2023.
- The survey collected data on surgeon-defined BMI cutoffs for hip and knee arthroplasty and the reasoning behind these decisions.
- Justifications explored included infection risk, comorbidities, equipment limitations, and adherence to American Academy of Orthopaedic Surgeons (AAOS) guidelines.
Main Results:
- 75% of surveyed surgeons utilize BMI cutoffs for hip and knee arthroplasty procedures.
- 91% of respondents reported significant responsibility in setting these BMI cutoffs.
- Mean BMI cutoffs were 40.5 for hip and 41 for knee arthroplasty, with justifications categorized into complication risk, surgical logistics, resource concerns, and surgeon perception.
Conclusions:
- BMI-based criteria for denying care highlight specific areas for improvement to enhance access to total hip arthroplasty (THA) and total knee arthroplasty (TKA).
- Understanding surgeon perspectives on BMI cutoffs is vital for future research aimed at overcoming barriers to essential orthopedic surgeries.
- Addressing these identified factors can help reduce disparities and improve outcomes for a growing patient population.
Background:
Many orthopedic surgeons choose not to perform joint arthroplasty on patients with a Body Mass Index (BMI) of 35 or above, citing poorer outcomes and increased procedure risk. Identifying and addressing factors surgeons use to determine procedure BMI cutoffs are necessary to increase access to orthopaedic care for this growing patient population. This will help reduce healthcare disparities while also identifying clinical facilities, equipment, training, and procedures that require improvements to accommodate larger individuals.
Methods:
Orthopaedic surgeons were surveyed to identify surgeon-specific BMI cutoffs for hip and knee arthroplasty. The survey was circulated within the California Orthopaedic Association (COA) report during March 2023. Questions aimed to identify BMI cutoffs and justifications such as infection risk, co-morbidities, inadequate equipment, and the American Academy of Orthopaedic Surgeons (AAOS) guidelines. Data on decision making about BMI cutoffs and exceptions were also collected.
Results:
75% of respondents use BMI cutoffs for hip and knee arthroplasty. 91% of respondents indicated they are either wholly or partially responsible for setting procedure BMI cutoffs. Mean hip and knee arthroplasty BMI cutoffs were 40.5 and 41, respectively. Four categories for BMI cutoff justifications were identified: (1) risk of complications; (2) surgery logistics; (3) concerns about facilities or resources; and (4) surgeon perception.
Conclusions:
BMI-based justifications for denial of care define key addressable areas of improvement that can increase access to care for life-changing orthopaedic surgeries such as THA and TKA. Insight from the queried surgeons will help drive future research areas to address this need.
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