Elsevier

The Journal of Arthroplasty

Volume 32, Issue 2, February 2017, Pages 362-366
The Journal of Arthroplasty

Health Policy and Economics
The Impact of Metabolic Syndrome on 30-Day Complications Following Total Joint Arthroplasty

https://doi.org/10.1016/j.arth.2016.08.007Get rights and content

Abstract

Background

The arthroplasty population increasingly presents with comorbid conditions linked to elevated risk of postsurgical complications. Current quality improvement initiatives require providers to more accurately assess and manage risk presurgically. In this investigation, we assess the effect of metabolic syndrome (MetS), as well as the effect of body mass index (BMI) within MetS, on the risk of complication following hip and knee arthroplasty.

Methods

We queried the American College of Surgeons National Surgical Quality Improvement Program database for total hip or knee arthroplasty cases. Thirty-day rates of Centers for Medicare and Medicaid Services (CMS)-reportable complications, wound complications, and readmissions were compared between patients with and without a diagnosis of MetS using multivariate logistic regression. Arthroplasty cases with a diagnosis of MetS were further stratified according to World Health Organization BMI class, and the role of BMI within the context of MetS was assessed.

Results

Of the 107,117 included patients, 11,030 (10.3%) had MetS. MetS was significantly associated with CMS complications (odds ratio [OR] = 1.415; 95% confidence interval [CI], 1.306-1.533; P < .001), wound complications (OR = 1.749; 95% CI, 1.482-2.064; P < .001), and readmission (OR = 1.451; 95% CI, 1.314-1.602; P < .001). When MetS was assessed by individual BMI class, the MetS + BMI >40 group was associated with significantly higher risk of CMS complications, wound complications, and readmission compared to the lower MetS BMI groups.

Conclusion

MetS is an independent risk factor for CMS-reportable complications, wound complications, and readmission following total joint arthroplasty. The risk attributable to MetS exists irrespective of obesity class and increases as BMI increases.

Section snippets

Data Acquisition and Definitions

Data were acquired from the American College of Surgeon's National Surgery Quality Improvement Program (ACS-NSQIP). In brief, the program consists of over 450 surgery centers, ranging from small community practices to urban academic hospitals. Data are collected through clinical nurse reviewers; these are highly trained, independent reporters designated and employed by NSQIP itself. The program provides reliable data that have been validated multiple times and used extensively in orthopedic

Results

After application of exclusion criteria, 107,117 patients were available for the study. Criteria for MetS were met by 10.3% (11,030) patients. MetS was associated with increased risk of CMS complications (odds ratio [OR] = 1.415; 95% confidence interval [CI], 1.306-1.533; P < .001), wound complications (OR = 1.749; 95% CI, 1.482-2.064; P < .001), and readmission (OR = 1.451; 95% CI, 1.314-1.602; P < .001).

Of those with MetS, 4174 (37.8%) had a BMI of 30-35; 3462 (31.4%) had a BMI 35-40; and

Discussion

The rising rate of obesity and its link to increased risk of developing osteoarthritis have contributed to a dramatic increase in the rate of obesity among those seeking joint replacement surgery 23, 24, 25. The association of obesity with higher risk of complication following arthroplasty has led to various risk mitigation efforts, even including bariatric surgery, but with mixed results 6, 26, 27. Along with the increased prevalence of obesity, there has been a corresponding rise in the

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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.08.007.

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