Obesity Correlates With 90-Day Postoperative Complications but Not 5-Year Retearing Rates After Anterior Cruciate...

While the relationship between obesity and adverse outcomes after anterior cruciate ligament (ACL) reconstruction has been studied, the relationship remains unclear due to conflicting reports from the existing literature.

The purpose was to assess the correlation of obesity with 90-day complications, readmissions, and 5-year retearing rates after ACL reconstruction using a large national cohort of patients. It was hypothesized that obesity would be associated with increased odds of adverse outcomes after ACL reconstruction.

Cohort study; Level of evidence, 3.

The PearlDiver Mariner M165Ortho patient claims database (2010-2022) was used to identify patients who underwent ACL reconstruction. Obese (body mass index, ≥30 kg/m²⁾ and nonobese patients were matched 1:1 based on age, sex, and comorbidity burden (Elixhauser Comorbidity Index). Outcomes included 90-day adverse events and readmission, which were assessed by univariate and multivariate analyses. Five-year rates of ipsilateral ACL retearing and contralateral ACL tearing were also assessed and compared with log-rank tests.

A total of 172,673 patients were identified, with obesity noted in 28,047 (16.2%). After matching the obese and nonobese cohorts, there were no differences in age, sex, or ECI between the 2 cohorts (P > .05 for all). Multivariate analysis showed that obesity was independently associated with increased odds of any adverse event (OR, 3.08; P < .001), serious adverse events (OR, 2.19; P < .001), and readmissions (OR, 6.40; P < .001). Specific complications linked to obesity included higher odds of the following, in decreasing odds ratio order: pneumonia (OR, 5.98), urinary tract infections (OR, 4.51), pulmonary embolism (OR, 3.97), sepsis (OR, 3.71), wound dehiscence (OR, 3.34), acute kidney injury (OR, 3.02), deep vein thrombosis (OR, 2.18), and surgical site infection (OR, 2.03) (P < .001 for all correlations). Over 5 years, there were no significant differences in the rates of ipsilateral or contralateral ACL tears between obese and nonobese patients (P = .5 and P = .6, respectively).

In a large cohort of patients, obesity was found to be associated with significantly increased odds of 90-day complications and readmissions after ACL reconstruction. Nonetheless, obesity was not correlated with 5-year rates of ipsilateral ACL retearing or contralateral ACL tearing after ACL reconstruction.