Thursday, October 29, 2015

Total shoulder arthroplasty and obesity

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty.

The authors queried the American College of Surgeons National Surgical Quality Improvement Program data base for 2006 to 2012 to compare the 30-day complication profile and hospitalization outcomes after primary total shoulder arthroplasty among patients in different BMI categories.

They identified 4796 patients in four BMI categories: normal (18.5-25 kg/m2), overweight (25-30 kg/m2), obesity Class 1 (30-35 kg/m2), and obesity Class 2 or greater (> 35 kg/m2). 

They found no association between BMI and 30-day complications after surgery. However, greater BMI was associated with longer surgical times.

Comment: It is of interest that patients having total shoulder arthroplasty were found to have a 5% complication rate, irrespective of their BMI. Interestingly, the patients with low BMI had almost twice the rates of blood transfusion and return to the operating room than their heavier counterparts as can be seen in this graph of their data.

We can conclude that BMI may not - of itself - be an important comorbidity for shoulder arthroplasty. However, associated conditions, such as obstructive sleep apnea, diabetes, shoulder hygiene, ability to self-care, general fitness, fall risk and others may require careful assessment and management before and after surgery.


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