THE EFFECT OF OBESITY ON INTRAOPERATIVE AND EARLY POSTOPERATIVE (IN HOSPITAL) COMPLICATIONS IN PATIENTS UNDERGOING TOTAL PROSTHESIS

Yıl 2022, Cilt: 23 Sayı: 2, 207 - 212, 20.04.2022

Bahattin Tuncalı Hakan Boya , Şükrü Araç

https://doi.org/10.18229/kocatepetip.810247

Öz

OBJECTIVE: Due to the increase in both obesity and total knee prosthesis arthroplasty (TKA), the number of TKA applications in obese patients has increased in recent years. However, it is debatable whether obesity is a risk factor for the complications observed in TKA. The aim of this study is to investigate the effect of obesity on intraoperative and early postoperative (in hospital) complications in patients with TKA.
MATERIAL AND METHODS: Patients were divided into 2 groups according to body mass index; Group 1: obese patients (Body mass index: BMI> 30 kg/m2), Group 2: non-obese patients (BMI≤30 kg/m2). Patient files were examined from 4 different perspectives (Demographic data, Preoperative features, Intraoperative features, Postoperative features). T-test was used in the analysis of parametric data, and Chi-square test was used in the analysis of non-parametric data. A value of P<0.05 was considered significant.
RESULTS: There was no statistically significant difference between the obese and non-obese patients in respect of the length of hospital stay, the operation time, the tourniquet time, the number of blood transfusions, presence of ischemic heart disease, diabetes, ASA scores, local skin complications, and systemic complications such as deep vein thrombosis, sepsis, pulmonary embolism and mortality. However, a statistically significant difference was found in presence of hypertension, hypothyroidism, and obstructive sleep apnea in the obese group.
CONCLUSIONS: There is no difference in terms of local and systemic complications in obese and non-obese patients undergoing TKA.

Anahtar Kelimeler

Knee, Arthroplasty, Complication, Obesity, Inpatient

Destekleyen Kurum

There is no institution or person contributing to the research.

Proje Numarası

This study was approved by the decision of the Clinical Research Ethics Committee of Başkent University, KA16/321

Teşekkür

-

TOTAL DİZ PROTEZİ UYGULANAN HASTALARDA OBESİTE VARLIĞININ İNTRAOPERATİF VE ERKEN POSTOPERATİF (HASTANEDE) KOMPLİKASONLAR ÜZERİNE OLAN ETKİSİ

Öz

AMAÇ: Hem obezitenin hem de total diz protezi (TDP) uygulamasının artışı ile birlikte, son yıllarda obez hastalarda TDP uygulama sayısı artmıştır. Obezitenin TDP uygulamasında izlenen komplikasyonlar için risk faktörü olup olmadığı tartışmalıdır. Bu çalışmanın amacı TDP uygulaması yapılan hastalarda intraoperatif ve erken postoperatif (hastanede) komplikasyonlar üzerine obezitenin etkisini araştırmaktır.
GEREÇ VE YÖNTEM: Hastalar vücut kitle endeksine göre 2 gruba ayrıldı; Grup 1: obez (Vücut kitle endeksi: VKE > 30 kg/m2), Grup 2: Obez olmayan (VKE ≤30 kg/m2). Hastaların dosyaları 4 farklı yönden değerlendirildi (Demografik veriler; Preoperatif, İntraoperatif, Postoperatif bulgular). Parametrik verilerin analizinde T-test, non-parametrik verilerin analizinde Ki-kare testi kullanıldı. P<0.05 değeri anlamlı kabul edildi.
BULGULAR: Obez olan ve olmayan hastalar arasında hastanede yatış, operasyon ve turnike süreleri, kan transfüzyonu sayısı, ASA (American Society of Anesthesiologists) puanları, İskemik kalp hastalığı, diyabet varlığı, lokal cilt komplikasyonları ve derin ven trombozu, sepsis, pulmoner emboli, mortalite gibi sistemik komplikasyonlar yönünden fark yoktu. Ancak obez grupta hipertansiyon, hipotiroidizm ve obstrüktif uyku apnesi istatistiksel olarak anlamlı oranda daha sık izlendi.
SONUÇ: Obez olan ve olmayan hastalara uygulanan TDP olguları arasında lokal ve sistemik komplikasyonlar yönünden fark yoktur.

Anahtar Kelimeler

Diz, Artroplasti, Komplikasyon, Obezite, Yatan hasta

Proje Numarası

This study was approved by the decision of the Clinical Research Ethics Committee of Başkent University, KA16/321

Kaynakça

• 1. Ng M, Fleming T, Robinson M et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:a systematic analysis for the Global Burden of Disease Study 201. Lancet. 2014;384:766-81.
• 2. Fehring TK, Odum SM, Griffin WL, et al. The obesity epidemic: its effect on total joint arthroplasty. J Arthroplasty. 2007;22:71-6.
• 3. Odum SM, Springer BD, Dennos AC, et al. National obesity trends in total knee arthroplasty. J Arthroplasty. 2013;28:48–51.
• 4. Lozano LM, Núñez M, Segur JM, et al. Relationship between knee anthropometry and surgical time in total knee arthroplasty in severely and morbidly obese patients: a new prognostic index of surgical difficulty. Obes Surg. 2008;18:1149-53.
• 5. Namba RS, Paxton L, Fithian DC, et al. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty. 2005;20:46-50.
• 6. Nuñez M1, Lozano L, Nuñez E, et al. Factors influencing health-related quality of life after TKA in patients who are obese. Clin Orthop Relat Res. 2011;469:1148-53.
• 7. Lozano LM, Tio M, Rios J, et al. Severe and morbid obesity (BMI ≥ 35 kg/m2) does not increase surgical time and length of hospital stay in total knee arthroplasty surgery. Knee Surg Sports Traumatol Arthrosc. 2015; 23(6):1713-9.
• 8. Amin AK, Clayton RA, Patton JT, et al. Total knee replacement in morbidly obese patients. Results of a prospective, matched study. J Bone Joint Surg. 2006;88:1321–6.
• 9. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res. 2009;467: 1577–81.
• 10. Gandhi K, Viscusi ER, Schwenk ES, et al. Quantifying cardiovascular risks in patients with metabolic syndrome undergoing total joint arthroplasty. J Arthroplasty. 2012;27:514–9.
• 11. Jamsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg. 2012;94:e101.
• 12. Jarvenpaa J, Kettunen J, Kroger H, et al. Obesity may impair the early outcome of total knee arthroplasty. Scand J Surg. 2010;99:45–9.
• 13. Kerkhoffs GM, Servien E, Dunn W, et al. Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am. 2012;94:1839–44.
• 14. Krushell RJ, Fingeroth RJ. Primary Total knee arthroplasty in morbidly obese patients: a 5- to 14-year follow-up study. J Arthroplasty. 2007;22:77–80.
• 15. Malinzak RA, Ritter MA, Berend ME, et al. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty. 2009;24:84–8.
• 16. Mantilla CB, Horlocker TT, Schroeder DR, et al. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Anesthesiology. 2003;99:552–60.
• 17. Namba RS, Paxton L, Fithian DC, et al. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty. 2005;20:46–50.
• 18. Peersman G, Laskin R, Davis J, et al. Infection in total knee replacement: a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.
• 19. Winiarsky R, Barth P, Lotke P. Total knee arthroplasty in morbidly obese patients. J Bone Joint Surg. 1998;80:1770–4.
• 20. Bordini B, Stea S, Cremonini S, et al. Relationship between obesity and early failure of total knee prostheses. BMC Musculoskelet Disord. 2009;5:10-29.
• 21. Chesney D, Sales J, Elton R, et al. Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty. 2008;23:355–9.
• 22. Dewan A, Bertolusso R, Karastinos A, et al. Implant durability and knee function after total knee arthroplasty in the morbidly obese patient. J Arthroplasty. 2009;24:89–94.
• 23. Friedman RJ, Hess S, Berkowitz SD, et al. Complication rates after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res. 2013;471: 3358–66.
• 24. Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res. 1993;289:175–9.
• 25. Miric A, Lim M, Kahn B, et al. Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg. 2002;15:77–83.
• 26. Patel VP, Walsh M, Sehgal B, et al. Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:33–8.
• 27. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–5.
• 28. Allen SR. Total knee and hip arthroplasty across BMI categories: a feasible option for the morbidly obese patient. J Surg Res. 2012;175:215-7.
• 29. Girardi F, Liu J, Guo Z et al. The impact of obesity on resource utilization among patients undergoing total joint arthroplasty. IntOrthop. 2019;43(2):269–74.
• 30. Nielsen KC, Guller U, Steele SM, et al. Pietrobon R. Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology. 2005;102:181–7.
• 31. Zusmanovich M, Kester B, Schwarzkopf R. Post-operative complications of total joint arthroplasty in obese patients stratifed by BMI. J Arthroplast. 2018;33(3):856–64.
• 32. Başdelioğlu K. Effects of body mass index on outcomes of total knee arthroplasty. Eur J Orthop Surg Traumatol. 2021;31:595-600.
• 33. Hakim J, Volpin G, Amashah M, et al. Long-term outcome of total knee arthroplasty in patients with morbid obesity. Int Orthop. 2020; 44, 95–104.
• 34. Suleiman LI, Ortega G, Ong’uti SK, et al. Does BMI affect perioperative complications following total knee and hip arthroplasty?. J Surg Res. 2012;174(1):7-11.
• 35. Abdulla I, Mahdavi S, Khong H, et al. Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database. 2020;27;63(2):142-149.
• 36. Crawford DA, Hurst JM, Morris MJ, et al. Impact of Morbid Obesity on Overnight Stay and Early Complications With Outpatient Arthroplasty. J Arthroplasty. 2020;35(9):2418- 22.
• 37. D’Apuzzo MR, Novicoff WM, Browne JA. Morbid Obesity Independently Impacts Complications, Mortality, and Resource Use After TKA. Clin Orthop Relat Res. 2015;473:57–63.
• 38. Abdel MP, Ast MP, Lee YY, et al. All-cause In-Hospital Complications and Urinary Tract Infections Increased in Obese Patients Undergoing Total Knee Arthroplasty. J Arthroplasty. 2014;29(7):1430-4.
• 39. Ayyar V, Burnett R, Coutts FJ, et al. The influence of obesity on patient reported outcomes following total knee replacement. Arthritis. 2012;2012:185208.
• 40. Amin AK, Patton JT, Cook RE, et al. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J BoneJoint Surg. 2006;88- B:335-40.