These authors point out that existing literature investigating the correlation of body mass index (BMI) with surgical complications has focused on those with elevated BMI. They analyzed the spectrum of categories for BMI with 30-day perioperative adverse events after primary total shoulder arthroplasty to assess where along the BMI spectrum patients are at risk for complications.
15,717 patients undergoing elective TSA were abstracted from the National Surgical Quality Improvement Program databases from 2005 to 2016. Patients were then aggregated into BMI categories, and 30-day adverse events were normalized to average risk of normal-weight subjects (BMI 18.5 to 24.9 kg/m2).
Underweight TSA patients (BMI < 18.5 kg/m2) had the greatest odds for multiple perioperative adverse events compared with any other BMI category.
In comparison to normal-weight patients, underweight patients were more likely to experience during the 30 days after surgery
-any adverse event (odds ratio [OR] = 2.22, P = 0.034),
-serious adverse events (OR = 3.18, P = 0.004), or
-have postoperative infections (OR = 2.77, P = 0.012).
No significant difference was observed in these complications for elevated BMI categories when compared with normal-weight patients.
Comment: The association of low BMI with complications has been previously noted for reverse total shoulders, see this link. Malnutrition, as indicated by a low serum albumin, is also a recognized risk factors (see this link). It remains to be seen if these risk factors can be effectively addressed before proceeding with shoulder arthroplasty.
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