Tuesday, October 27, 2020

Is it safe to operate on patients with obesity?

 Level of Obesity is Directly Associated with Complications Following Arthroscopic Rotator Cuff Repair

These authors investigated the association between increasing levels of obesity and postoperative complications within 30 days of arthroscopic rotator cuff repair.

18,521 patients who underwent arthroscopic rotator cuff repair (ARCR) from 2015-2017were identified in the American College of Surgeons National Surgical Quality Improvement and stratified into three cohorts according to their body mass index (BMI). Patients with BMI <30 kg/m2 were placed in the nonobese cohort, patients with BMI between 30-40 kg/m2 were placed in the obese cohort, and patients with BMI >40 kg/m2 were placed in the morbidly obese cohort. 9,548 (51.6%) of the patients were nonobese, 7,438 (40.2%) were obese, and 1,535 (8.3%) were morbidly obese. 

Multivariate logistic regression was employed to investigate the relationship between increasing levels of obesity and postoperative complications within 30 days of surgery.

Among nonobese, obese, and morbidly obese patients showed increasing rates of complications.

In comparison to nonobese patients, multivariate analysis identified both obesity and morbid obesity as significant predictors of medical complications (OR 1.72; OR 2.16), pulmonary complications (OR 2.66; OR 4.06), and overall complications (OR 1.52; OR 1.77).

Among obese patients undergoing ARCR, functional dependence, COPD, steroid use, and diabetes were identified as comorbidities which also increased the risk of short-term complications.

Comment: These results are important. It seems reasonable to expect that the same risk profile for medical complications would apply to other surgeries, such as arthroplasty. 

The authors refer to obesity as a "modifiable" risk factor. It is, however, unclear how modifiable obesity is and whether having the patient shed some pounds will increase the safety of shoulder surgery.

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