K. Spaniolas2, M. Grzybowski1, M. Ball1, Z. Schafer1, W. Pories1 1East Carolina University Brody School Of Medicine,Greenville, NC, USA 2Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: With the national increase in obesity, total knee/hip arthroplasty (TKHA) rates in the severely obese are accelerating. Success rates in this patient population are less established. Bariatric surgery, however, leads to sustainable weight loss, decreased symptoms of osteoarthritis, and broader health benefits apart from osteoarthritis. This study investigated 30-day morbidity in severely obese patients undergoing TKHA and elective laparoscopic bariatric (BAR).
Methods: Using ACS-NSQUIP 2006-2013 data, a retrospective cohort of 105,108 severely obese patients were eligible following the application of exclusion criteria (TKHA n=31436, BAR n=73672). Propensity matching kept 6,282 in each treatment group (c=.94). Rates and odds ratios (ORs) and 95% confidence intervals (CIs) were computed for the ORs: unadjusted (ORu), age and sex-adjusted (ORa), and propensity-adjusted (ORp) associations for serious morbidity.
Results: Among 12,564 matched patients, the mean age (SD) and BMI (SD) were 56 (8.1) and 43.3 (5.7), respectively, with 70% being female. For serious morbidity the unadjusted and propensity-adjusted rates for TKHA and BAR, respectively, were 54.7% vs 45.3% and 8.2% vs 2.8%. The ORu=.32 (.30-.33), p<.0001; OR(a)=.44 (.41-.46), p<.0001, and ORp=.25 (.21-.29), p<.0001.
Conclusion: Our findings suggest BAR is associated a 75% less likelihood of developing serious early postoperative morbidity after matching on many confounders than TKHA. However, more evidence-based longitudinal studies are needed to assess the efficacy of both procedures.