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Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes
  1. Jiabin Liu1,2,
  2. Haoyan Zhong1,
  3. Jashvant Poeran3,
  4. Peter K Sculco4,
  5. David H Kim1,2 and
  6. Stavros G Memtsoudis1,2
  1. 1Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
  2. 2Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
  3. 3Depts of Population Health Science & Policy/Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
  1. Correspondence to Dr Jiabin Liu, Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA; liuji{at}hss.edu

Abstract

Background Patients with morbid obesity may require both bariatric surgery and total knee/hip arthroplasty (TKA/THA). How to sequence these two procedures with better outcomes remains largely unstudied.

Methods This cohort study extracted claims data on patients with an obesity diagnosis that received both bariatric surgery and TKA/THA surgery within 5 years of each other (Premier Healthcare database 2006–2019). Overall, 1894 patients received bariatric surgery before TKA or THA, while 1000 patients underwent TKA or THA before bariatric surgery. Main outcomes and measures include major complications (acute renal failure, acute myocardial infarction, other cardiovascular complications, sepsis/septic shock, pulmonary complications, pulmonary embolism, pneumonia, and central nervous system-related adverse events), postoperative intensive care unit utilization, ventilator utilization, 30-day readmission, 90-day readmission, 180-day readmission and total hospital length of stay after the second surgery. Regression models measured the association between the complications and sequence of TKA/THA and bariatric surgery.

Results Undergoing TKA/THA before bariatric surgery (compared with the reverse) was associated with higher odds of major complications (7.0% vs 1.9%; adjusted OR 4.8, 95% CI 3.1, 7.6, p<0.001). Similar patterns were also observed for intensive care unit admission, ventilator use postoperatively, 30-day, and 90-day readmissions. Patients who received a second surgery within 6 months of their first surgery exhibited worse outcomes, especially among the TKA/THA first patient cohort. Major complication incidences occurred at 20.5%, 12.5%, 5.1%, 5.0%, 5.8% and 8.5% with time between TKA/THA and bariatric surgery at <6 months, 6 months–1 year, 1–2, 2–3, 3–4 and 4–5 years, respectively.

Conclusions Patients who require both bariatric surgery and TKA/THA should consider bariatric surgery before TKA/THA as it is associated with improved outcomes. Procedures should be staged beyond 6 months.

  • outcomes
  • outcome assessment
  • health care
  • treatment outcome
  • postoperative complications

Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are commercially available from Premier Healthcare database (Premier Healthcare Solutions, Charlotte, North Carolina, USA).

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Data availability statement

Data may be obtained from a third party and are not publicly available. The data used in this study are commercially available from Premier Healthcare database (Premier Healthcare Solutions, Charlotte, North Carolina, USA).

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Footnotes

  • Twitter @jbLiujb, @jashvant_p, @sgmemtsoudis

  • Contributors JL, JP, and SGM: conception, study design, analysis and interpretation of data, and drafting manuscript. HZ: data analysis and drafting manuscript. PKS and DHK: conception, interpretation of data, and drafting manuscript.

  • 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 None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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