J Knee Surg 2021; 34(12): 1275-1283
DOI: 10.1055/s-0040-1708038
Original Article

Trends of Obese and Morbidly Obese Patients in Same-Day Bilateral Total Knee Arthroplasty from 2009 to 2016

Ethan A. Remily
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Wayne A. Wilkie
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Nequesha S. Mohamed
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Mark Pastore
2   Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
,
Anthony Viola
2   Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
,
Abraham H. Cho
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
James Nace
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
1   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
› Author Affiliations

Abstract

As obesity in the United States increases, the proportion of obese and morbidly obese patients undergoing same-day bilateral total knee arthroplasty (sd-BTKA) remains unknown. Therefore, this study analyzed: (1) incidence, (2) patient demographics, (3) patient course, and (4) patient outcomes in obese and morbidly obese patients undergoing sd-BTKA in the United States from 2009 to 2016. The National Inpatient Sample was queried for all sd-BTKA patients from 2009 to 2016, yielding 39,901 obese and 20,394 morbidly obese patients. Analyzed variables included overall incidence, age, length of stay (LOS), sex, race, payer, Charlson comorbidity index (CCI) status, disposition, complications, location/teaching status, region of hospital, costs, and charges. Categorical variables were evaluated with chi-square analysis, while continuous variables were analyzed by Student's t-tests. Overall, the number of sd-BTKAs decreased over the study period, although the proportion of both obese and morbidly obese patients increased (p < 0.001 for all). The most common CCI status, 3 + , decreased in proportion for both groups (p < 0.001 for all). Hospital costs decreased and charges increased for both groups (p < 0.001 for all). Mean LOS decreased and patients were most commonly discharged to skilled nursing facilities, although these proportions decreased (p < 0.001 for all). Respiratory failures (p < 0.001 for all) increased for both groups, while proportion of deep vein thromboses and hematomas/seromas (p < 0.001 for all) increased for obese patients and proportion of pulmonary emboli (p < 0.001) increased for morbidly obese patients. The results of this study appear to portray improving optimization and patient selection of higher body mass index (BMI) individuals undergoing this procedure. More information is needed comparing the safety of the sd-BTKA across patients of all BMI groups.



Publication History

Received: 06 September 2019

Accepted: 23 January 2020

Article published online:
07 April 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief 2017; (288) 1-8
  • 2 Finkelstein EA, Khavjou OA, Thompson H. et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med 2012; 42 (06) 563-570
  • 3 Davis MA, Ettinger WH, Neuhaus JM, Cho SA, Hauck WW. The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. Am J Epidemiol 1989; 130 (02) 278-288
  • 4 Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas 2016; 89: 22-28
  • 5 Carr AJ, Robertsson O, Graves S. et al. Knee replacement. Lancet 2012; 379 (9823): 1331-1340
  • 6 Robertsson O, Bizjajeva S, Fenstad AM. et al. Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association. Acta Orthop 2010; 81 (01) 82-89
  • 7 Bourne R, Mukhi S, Zhu N, Keresteci M, Marin M. Role of obesity on the risk for total hip or knee arthroplasty. Clin Orthop Relat Res 2007; 465: 185-188
  • 8 Madsen AA, Taylor BC, Dimitris C, Hansen DC, Steensen RA, Gaines ST. Safety of bilateral total knee arthroplasty in morbidly obese patients. Orthopedics 2014; 37 (03) e252-e259
  • 9 Memtsoudis SG, Hargett M, Russell LA. et al. Consensus statement from the consensus conference on bilateral total knee arthroplasty group. Clin Orthop Relat Res 2013; 471 (08) 2649-2657
  • 10 Hart A, Antoniou J, Brin YS, Huk OL, Zukor DJ, Bergeron SG. Simultaneous bilateral versus unilateral total knee arthroplasty: a comparison of 30-day readmission rates and major complications. J Arthroplasty 2016; 31 (01) 31-35
  • 11 Hu J, Liu Y, Lv Z, Li X, Qin X, Fan W. Mortality and morbidity associated with simultaneous bilateral or staged bilateral total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2011; 131 (09) 1291-1298
  • 12 Stefánsdóttir A, Lidgren L, Robertsson O. Higher early mortality with simultaneous rather than staged bilateral TKAs: results from the Swedish Knee Arthroplasty Register. Clin Orthop Relat Res 2008; 466 (12) 3066-3070
  • 13 Lindberg-Larsen M, Pitter FT, Husted H, Kehlet H, Jørgensen CC. ; Lundbeck Foundation Centre for Fast-Track Hip and Knee Replacement Collaborative Group. Simultaneous vs staged bilateral total knee arthroplasty: a propensity-matched case-control study from nine fast-track centres. Arch Orthop Trauma Surg 2019; 139 (05) 709-716
  • 14 Fu D, Li G, Chen K, Zeng H, Zhang X, Cai Z. Comparison of clinical outcome between simultaneous-bilateral and staged-bilateral total knee arthroplasty: a systematic review of retrospective studies. J Arthroplasty 2013; 28 (07) 1141-1147
  • 15 Powell RS, Pulido P, Tuason MS, Colwell Jr CW, Ezzet KA. Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. J Arthroplasty 2006; 21 (05) 642-649
  • 16 Fick D, Crane T, Shakespeare D. A comparison of bilateral vs. unilateral total knee arthroplasty mobilised using a flexion regime. Knee 2002; 9 (04) 285-289
  • 17 March LM, Cross M, Tribe KL. et al. Arthritis C.O.S.T. Study Project Group. Two knees or not two knees? Patient costs and outcomes following bilateral and unilateral total knee joint replacement surgery for OA. Osteoarthritis Cartilage 2004; 12 (05) 400-408
  • 18 Odum SM, Troyer JL, Kelly MP, Dedini RD, Bozic KJ. A cost-utility analysis comparing the cost-effectiveness of simultaneous and staged bilateral total knee arthroplasty. J Bone Joint Surg Am 2013; 95 (16) 1441-1449
  • 19 Memtsoudis SG, Besculides MC, Reid S, Gaber-Baylis LK, González Della Valle A. Trends in bilateral total knee arthroplasties: 153,259 discharges between 1990 and 2004. Clin Orthop Relat Res 2009; 467 (06) 1568-1576
  • 20 Meehan JP, Blumenfeld TJ, White RH, Kim J, Sucher M. Risks and benefits of simultaneous bilateral total knee arthroplasty: a critical analysis review. JBJS Rev 2015; 3 (02) 01874474 -201503020-00002
  • 21 Vazquez-Vela Johnson G, Worland RL, Keenan J, Norambuena N. Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement. J Bone Joint Surg Br 2003; 85 (01) 52-56
  • 22 Roche M, Law TY, Kurowicki J, Rosas S, Rush III AJ. Effect of obesity on total knee arthroplasty costs and revision rate. J Knee Surg 2018; 31 (01) 38-42
  • 23 Kremers HM, Visscher SL, Kremers WK, Naessens JM, Lewallen DG. The effect of obesity on direct medical costs in total knee arthroplasty. J Bone Joint Surg Am 2014; 96 (09) 718-724
  • 24 McElroy MJ, Pivec R, Issa K, Harwin SF, Mont MA. The effects of obesity and morbid obesity on outcomes in TKA. J Knee Surg 2013; 26 (02) 83-88
  • 25 Overview of the National (Nationwide) Inpatient Sample. (NIS). Accessed August 23, 2019 at: https://www.hcup-us.ahrq.gov/nisoverview.jsp 2019
  • 26 Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2007; 89 (06) 1220-1226
  • 27 Luscombe JC, Theivendran K, Abudu A, Carter SR. The relative safety of one-stage bilateral total knee arthroplasty. Int Orthop 2009; 33 (01) 101-104
  • 28 Yoon HS, Han CD, Yang IH. Comparison of simultaneous bilateral and staged bilateral total knee arthroplasty in terms of perioperative complications. J Arthroplasty 2010; 25 (02) 179-185
  • 29 Woon CY, Piponov H, Schwartz BE. et al. Total knee arthroplasty in obesity: in-hospital outcomes and national trends. J Arthroplasty 2016; 31 (11) 2408-2414
  • 30 DeMik DE, Bedard NA, Dowdle SB. et al. Complications and obesity in arthroplasty-a hip is not a knee. J Arthroplasty 2018; 33 (10) 3281-3287
  • 31 Ji Y-B, Wang C-Y, Wang X-N, Jin H. Evaluating the effect of obesity on total knee arthroplasty: a longitudinal study. J Pak Med Assoc 2017; 67 (01) 3-6
  • 32 Torres-Claramunt R, Hinarejos P, Leal-Blanquet J. et al. Does obesity influence on the functional outcomes of a total knee arthroplasty?. Obes Surg 2016; 26 (12) 2989-2994
  • 33 George J, Piuzzi NS, Ng M, Sodhi N, Khlopas AA, Mont MA. Association between body mass index and thirty-day complications after total knee arthroplasty. J Arthroplasty 2018; 33 (03) 865-871
  • 34 Yang G, De Staercke C, Hooper WC. The effects of obesity on venous thromboembolism: a review. Open J Prev Med 2012; 2 (04) 499-509
  • 35 Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis 2016; 41 (01) 3-14
  • 36 Buntin MB, Deb P, Escarce JJ, Hoverman C, Paddock SM, Sood N. Comparison of Medicare Spending and Outcomes for Beneficiaries with Lower Extremity Joint Replacements. Santa Monica, CA: RAND Corporation; 2005. https://www.rand.org/pubs/working_papers/WR271.html Accessed August 28, 2019.
  • 37 Grace TR, Tsay EL, Roberts HJ, Vail TP, Ward DT. Staged bilateral total knee arthroplasty: increased risk of recurring complications. J Bone Joint Surg 2020; 102 (04) 292-297