Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty.

Autor: Sherman WF; Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA., Patel AH; Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA., Kale NN; Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA., Freiberger CM; Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA., Barnes CL; Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR., Lee OC; Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center and Southeast Louisiana Veterans Health Care System, New Orleans, LA.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2021 Aug; Vol. 36 (8), pp. 2708-2715.e1. Date of Electronic Publication: 2021 Mar 06.
DOI: 10.1016/j.arth.2021.02.078
Abstrakt: Background: Obesity is a risk factor for complications after total joint arthroplasty (TJA). This study analyzed the impact of individual surgeon demographics, financial concerns, and other factors in determining patient candidacy for TJA based on body mass index (BMI).
Methods: A 21-question survey was approved by the American Association of Hip and Knee Surgeons Research Committee for distribution to its membership. Objective questions asked about surgeon or hospital BMI thresholds for offering TJA. Subjective questions asked about physician comfort discussing topics including obesity, bariatric surgery, and weight loss before TJA, as well as insurance and age considerations.
Results: For TJA procedures, 49.9% of surgeons had a BMI cutoff at 40, 24.5% at 45, and 8.3% at 50. At a BMI cutoff of 40, 23.8% of surgeons felt their patient volume would be adversely affected, whereas at a BMI cutoff of 35, 50% of surgeons felt their patient volume would be adversely affected. Surgeons were more likely to not perform total hip arthroplasty on patients with morbid obesity than total knee arthroplasty (P = .037). Significantly more academic surgeons did not have cutoffs for total hip arthroplasty (P = .003) or total knee arthroplasty (P < .001) compared with all other practice settings.
Conclusion: There are myriad factors that affect surgeon BMI thresholds for offering elective TJA including poor outcomes, hospital thresholds, financial considerations, and the well being of the patient. Further work should be performed to minimize the risks associated with TJA while providing the best possible care to patients with morbid obesity.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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