Faculty Collaboration Database

The Impact of Metabolic Syndrome on 30-Day Complications Following Total Joint Arthroplasty. J Arthroplasty 2017 02;32(2):362-366

Date

09/22/2016

Pubmed ID

27651122

DOI

10.1016/j.arth.2016.08.007

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.

Author List

Edelstein AI, Lovecchio F, Delagrammaticas DE, Fitz DW, Hardt KD, Manning DW

Author

Adam I. Edelstein MD Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Body Mass Index
Cohort Studies
Comorbidity
Databases, Factual
Female
Humans
Logistic Models
Male
Metabolic Syndrome
Middle Aged
Multivariate Analysis
Obesity
Odds Ratio
Patient Readmission
Postoperative Complications
Postoperative Period
Quality Improvement
Risk Factors
Societies, Medical
United States