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Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes: an infographic
  1. Rajnish K Gupta1 and
  2. Eric S Schwenk2
  1. 1 Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Rajnish K Gupta, Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; raj.gupta{at}

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There has been significant debate regarding whether patients with high body mass index should have bariatric surgery or total knee/hip arthroplasty (TKA/THA) first if they are scheduled to have both. Liu et al have published a retrospective database analysis study to help address this question.1 In their review of 2894 patients who underwent both operations within a 5-year period, they determined that performing TKA/THA before performing bariatric surgery was associated with an OR of 4.8 times higher risk of major complications (7.0% vs 1.9%). In addition, there was a similarly high risk of postoperative need for intensive care unit (ICU) admission (OR 6.8), postoperative need for ventilator use (OR 13.1), 30-day readmission (OR 6.9), and 90-day readmission (OR 2.2). Of note was that patients having their second surgery within 6 months of their first surgery, regardless of which operation was performed first, had significantly poorer outcomes. Their assessment suggests that performing bariatric surgery prior to TKA/THA would be advisable when both operations are planned for a patient. In addition, regardless of which surgery is done first, the second operation should be delayed until at least 6 months after the first.

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We would like to acknowledge Jim Snively, artist, of Pittsburgh, Pennsylvania, USA, for creation of this infographic.



  • Twitter @dr_rajgupta, @ESchwenkMD

  • Contributors Both authors contributed to the origination, editing, and approval of the submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Both authors are co-associate editors of Regional Anesthesia and Pain Medicine.

  • Provenance and peer review Commissioned; internally peer reviewed.

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