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Increased patient body mass index is associated with increased surgeon physiologic stress during total hip arthroplasty

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

While increased body mass index (BMI) in patients undergoing total hip arthroplasty (THA) increases surgical complexity, there is a paucity of objective studies assessing the impact of patient BMI on the cardiovascular stress experienced by surgeons during THA. The aim of this study was to assess the impact of patient BMI on surgeon cardiovascular strain during THA.

Methods

We prospectively evaluated three fellowship-trained arthroplasty surgeons performing a total of 115 THAs. A smart-vest worn by the surgeons recorded mean heart rate, stress index (correlate of sympathetic activation), respiratory rate, minute ventilation, and energy expenditure throughout the procedures. Patient demographics as well as perioperative data including surgical approach, surgery duration, number of assistants, and the timing of the surgery during the day were collected. Linear regression was utilized to assess the impact of patient characteristics and perioperative data on cardiorespiratory metrics.

Results

Average surgeon heart rate, energy expenditure, and stress index during surgery were 98.50 beats/min, 309.49 cal/h, and 14.10, respectively. Higher patient BMI was significantly associated with increased hourly energy expenditure (P = 0.027), mean heart rate (P = 0.037), and stress index (P = 0.027) independent of surgical approach. Respiratory rate and minute ventilation were not associated with patient BMI. The number of assistants and time of surgery during the day did not impact cardiorespiratory strain on the surgeon.

Conclusion

The physiologic burden on surgeons during primary THA significantly increases as patient BMI increases. This study suggests that healthcare systems should consider adjusting reimbursement models to account for increased surgeon workload due to obesity. Further surgeons should adopt strategies in operative planning and case scheduling to handle this added physical strain.

Level of evidence

III.

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References

  1. Shichman I, Roof M, Askew N et al (2023) Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040–2060. JB JS Open Access. https://doi.org/10.2106/JBJS.OA.22.00112

    Article  PubMed  PubMed Central  Google Scholar 

  2. McQuivey KS, Christopher ZK, Deckey DG et al (2021) Surgical ergonomics and musculoskeletal pain in arthroplasty surgeons. J Arthroplasty 36:3781–3787.e7. https://doi.org/10.1016/J.ARTH.2021.06.026

    Article  PubMed  Google Scholar 

  3. Alqahtani SM, Alzahrani MM, Tanzer M (2016) Adult Reconstructive Surgery: a high-risk profession for work-related injuries. J Arthroplasty 31:1194–1198. https://doi.org/10.1016/J.ARTH.2015.12.025

    Article  PubMed  Google Scholar 

  4. Davis WT, Sathiyakumar V, Jahangir AA et al (2013) Occupational injury among orthopaedic surgeons. J Bone Joint Surg Am 95:e107. https://doi.org/10.2106/JBJS.L.01427

    Article  PubMed  Google Scholar 

  5. CMS, CM, PCG, Dpipd how to use the MPFS look-up tool print-friendly version what’s changed? MLN booklet how to use the MPFS look-up tool

  6. Introduction to relative value units and how Medicare reimbursement in calculated

  7. Khan IA, Haffar A, Magnuson JA et al (2022) Primary hip and knee arthroplasty surgeons experience greater cardiorespiratory strain and stress during total hip arthroplasty than total knee arthroplasty. J Arthroplasty 37:637–641. https://doi.org/10.1016/j.arth.2021.12.007

    Article  PubMed  Google Scholar 

  8. Khan IA, Baker CM, Magnuson JA et al (2022) Surgeons experience more physiologic stress and strain during revision than primary total joint arthroplasty. J Arthroplasty. https://doi.org/10.1016/J.ARTH.2022.12.022

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sharkey PF, Danoff JR, Klein G, Parvizi J (2007) Surgeon energy expenditure during total joint arthroplasty. J Arthroplasty 22:210–212. https://doi.org/10.1016/J.ARTH.2006.08.002

    Article  PubMed  Google Scholar 

  10. Haffar A, Khan IA, Ong C et al (2022) Stress and strain during total joint arthroplasty are not impacted by hand dominance or operative laterality in orthopedic surgeons. J Arthroplasty 37:1054–1058. https://doi.org/10.1016/J.ARTH.2022.02.073

    Article  PubMed  Google Scholar 

  11. Review WP (2021) Obesity rates by Country 2021

  12. Products—Data Briefs—Number 360—February 2020. https://www.cdc.gov/nchs/products/databriefs/db360.htm. Accessed 7 Nov 2022

  13. Obesity Rates by Country (2023). https://worldpopulationreview.com/country-rankings/obesity-rates-by-country. Accessed 21 Dec 2023

  14. George J, Klika AK, Navale SM et al (2017) Obesity epidemic: Is its impact on total joint arthroplasty underestimated? an analysis of national trends. Clin Orthop Relat Res 475:1798–1806. https://doi.org/10.1007/S11999-016-5222-4/FIGURES/5

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rhind JH, Baker C, Roberts PJ (2020) Total hip arthroplasty in the obese patient: tips and tricks and review of the literature. Indian J Orthop 54:776. https://doi.org/10.1007/S43465-020-00164-W

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smith EL, Tybor DJ, Daniell HD et al (2018) The 22-modifier in reimbursement for orthopedic procedures: hip arthroplasty and obesity are worth the effort. J Arthroplasty 33:2047–2049. https://doi.org/10.1016/J.ARTH.2018.02.058

    Article  PubMed  Google Scholar 

  17. Villar R, Beltrame T, Hughson RL (2015) Validation of the Hexoskin wearable vest during lying, sitting, standing, and walking activities. Appl Physiol Nutr Metab 40:1019–1024. https://doi.org/10.1139/APNM-2015-0140

    Article  PubMed  Google Scholar 

  18. Lipponen JA, Tarvainen MP (2019) A robust algorithm for heart rate variability time series artefact correction using novel beat classification. J Med Eng Technol 43:173–181. https://doi.org/10.1080/03091902.2019.1640306

    Article  PubMed  Google Scholar 

  19. Jameson SS, Mason JM, Baker PN et al (2014) The impact of body mass index on patient reported outcome measures (PROMs) and complications following primary hip arthroplasty. J Arthroplasty 29:1889–1898. https://doi.org/10.1016/j.arth.2014.05.019

    Article  PubMed  Google Scholar 

  20. Arnold N, Anis H, Barsoum WK et al (2020) Preoperative cut-off values for body mass index deny patients clinically significant improvements in patient-reported outcomes after total hip arthroplasty. Bone Joint J 102-B:683–692. https://doi.org/10.1302/0301-620X.102B6.BJJ-2019-1644.R1

    Article  PubMed  Google Scholar 

  21. Stern LC, Kraay MJ (2011) Total knee arthroplasty in the obese patient. YSART 22:153–156. https://doi.org/10.1053/j.sart.2011.07.005

    Article  Google Scholar 

  22. Imbuldeniya AM, Pearce SJ, Walter WL et al (2013) Increasing patient obesity: Do I or do I not operate? Semin Arthroplasty 24:128–131. https://doi.org/10.1053/J.SART.2013.08.004

    Article  Google Scholar 

  23. Rankin KA, Gibson D, Schwarzkopf R et al (2022) Operative techniques to reduce hip and knee arthroplasty complications in morbidly obese patients. Arthroplast Today 17:120. https://doi.org/10.1016/J.ARTD.2022.07.016

    Article  PubMed  PubMed Central  Google Scholar 

  24. Haffar A, Krueger CA, Goh GS, Lonner JH (2022) Total knee arthroplasty with robotic surgical assistance results in less physician stress and strain than conventional methods. J Arthroplasty 37:S193–S200. https://doi.org/10.1016/J.ARTH.2021.11.021

    Article  PubMed  Google Scholar 

  25. (2016) Modifier 22 fact sheet. CMS Internet-Only Manual Chapter 12

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA

    Itay Ashkenazi, Kyle W. Lawrence, Claudette M. Lajam, Ran Schwarzkopf & Joshua C. Rozell

  2. Division of Orthopedic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Itay Ashkenazi & Ittai Shichman

Authors
  1. Itay Ashkenazi
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  2. Kyle W. Lawrence
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  3. Ittai Shichman
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  4. Claudette M. Lajam
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  5. Ran Schwarzkopf
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  6. Joshua C. Rozell
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Corresponding author

Correspondence to Joshua C. Rozell.

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Conflict of interest

IA, KWL, and IS have nothing to disclose. CML reports being a paid employee for Pfizer, an unpaid consultant for FundamentalVR, and receives royalties from Elsevier. RS reports IP royalties from Smith & Nephew, being paid consultant for Smith & Nephew, Zimmer and Intellijoint, have stock options from intellijoint, Gauss Surgical and PSI, and receives research support from Smith & Nephew and Intellijoint. JCR reports being a paid consultant for Aerobiotix, DePuy, and Zimmer.

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The present study was exempt from human-subject review by our institutional review board (IRB).

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Ashkenazi, I., Lawrence, K.W., Shichman, I. et al. Increased patient body mass index is associated with increased surgeon physiologic stress during total hip arthroplasty. Arch Orthop Trauma Surg (2024). https://doi.org/10.1007/s00402-024-05251-3

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