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Impact of low body mass index on reoperation risk and complications after joint arthroplasty: a cohort study
Pakpoom Ruangsomboon1, Onlak Ruangsomboon2,3, Ossama Al-Obaedi4
1Sunnybrook Holland Orthopaedic and Arthritic Centre, Division of Orthopaedic Surgery, University of Toronto, Ontario, Toronto, Canada. pakpoom.ruangsomboon@mail.utoronto.ca.
Insights
Patients with low body mass index (BMI) undergoing arthroplasty face higher risks of reoperation and complications. Preoperative optimization and vigilant postoperative care are crucial for this high-risk group.
Area of Science:
- Orthopaedic surgery
- Patient outcomes research
- Body mass index research
Background:
- The impact of low body mass index (BMI) on arthroplasty outcomes is not well understood.
- Elevated BMI is linked to adverse outcomes, but low BMI may also present unique challenges such as malnutrition and increased surgical risks.
- This study investigates the risks associated with low BMI in patients undergoing total hip or knee arthroplasty.
Purpose of the Study:
- To evaluate the impact of low BMI on reoperation risk and other complications.
- To compare outcomes of low BMI patients (<20 kg/m²) with normal BMI patients (20-24.9 kg/m²) undergoing arthroplasty.
- To identify specific challenges faced by low BMI patients in arthroplasty.
Main Methods:
- Retrospective cohort study of 1,162 arthroplasty patients (hip or knee) between 2012 and 2023.
- Patients stratified into low BMI (<20 kg/m²) and normal BMI (20-24.9 kg/m²) groups.
- Outcomes analyzed using survival analysis and multivariate Cox proportional hazards models, focusing on reoperation and composite complications.
Main Results:
- Low BMI patients (15.7%) showed significantly higher risks of reoperation and composite complications compared to normal BMI patients (p < 0.001).
- Low BMI was independently associated with a 5.8-fold increased risk of reoperation (aHR, 5.8; 95% CI, 2.8-12.1).
- Low BMI was independently associated with a 7.5-fold increased risk of composite complications (aHR, 7.5; 95% CI, 3.9-14.5).
Conclusions:
- Low body mass index (<20 kg/m²) is a significant risk factor for reoperation and complications after arthroplasty.
- Findings highlight the need for tailored preoperative optimization strategies for low BMI patients.
- Vigilant postoperative monitoring and care are essential for improving outcomes in this high-risk arthroplasty population.
Purpose:
The risks associated with low body mass index (BMI) in arthroplasty patients are underexplored. While outcomes of patients with elevated BMI are well-documented, low BMI patients may also face unique challenges, including malnutrition, osteopenia, and increased surgical risks and postoperative complications. To evaluate the impact of low BMI on reoperation risk and other complications compared with normal BMI among patients undergoing total hip or knee arthroplasty.
Methods:
This retrospective cohort study analyzed electronic health records of patients with BMI < 25 kg/m² who underwent hip or knee arthroplasty at Sunnybrook Holland Orthopaedic & Arthritic centre, Toronto, Canada between April 2, 2012, and April 6, 2023. Patients were stratified into low BMI (< 20 kg/m²) and normal BMI (20-24.9 kg/m²) groups, with their outcomes followed until November 2024. The main exposure was BMI categorized as low or normal. Other covariates controlled for were relevant demographics and comorbidities. The primary outcome was the risk of reoperation. The secondary outcome was composite complications (persistent pain, wound issues, and radiographic abnormalities). Survival analysis was performed with probabilities visualized with Kaplan-Meier curves. Multivariate Cox proportional hazards models were employed adjusting for potential confounders.
Results:
Among 1,162 included patients (mean [standard deviation] age, 68.8 [11.1] years; 70.1% women), 182 (15.7%) had low BMI and 980 (84.3%) had normal BMI. Kaplan-Meier curves demonstrated significantly higher risks of reoperation and composite complications in patients with low BMI compared to those with normal BMI (both p < 0.001). After adjusting for other covariates, low BMI was independently associated with increased risks of reoperation (adjusted Hazard Ratio (aHR), 5.8; 95% confidence interval (CI), 2.8-12.1; p < 0.001) and composite complications (aHR, 7.5; 95% CI, 3.9-14.5; p < 0.001).
Conclusions:
In this large cohort of arthroplasty patients, BMI < 20 kg/m² was associated with elevated risks of reoperation and composite complications. These findings emphasize the importance of tailored preoperative optimization and vigilant postoperative care for this high-risk population.
Level Of Evidence:
Level III.
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