Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications.
| Autor: | Elcock KL; University of Edinburgh, Edinburgh, UK., Carter TH; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK., Yapp LZ; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK., MacDonald DJ; Department of Orthopaedics, University of Edinburgh, Edinburgh, UK., Howie CR; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.; Department of Orthopaedics, University of Edinburgh, Edinburgh, UK., Stoddart A; Usher Institute, Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK., Berg G; Healthcare Improvement Scotland, Edinburgh, UK., Clement ND; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK., Scott CEH; Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.; Department of Orthopaedics, University of Edinburgh, Edinburgh, UK. |
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| Jazyk: | angličtina |
| Zdroj: | The bone & joint journal [Bone Joint J] 2022 Apr; Vol. 104-B (4), pp. 452-463. |
| DOI: | 10.1302/0301-620X.104B4.BJJ-2021-0353.R3 |
| Abstrakt: | Aims: Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m 2 ). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m 2 to examine whether this is supported. Methods: This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m 2 ) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m 2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m 2 in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient's lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. Results: All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m 2 : 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m 2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m 2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m 2 . In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m 2 and £5,275 in patients with a BMI ≥ 40 kg/m 2 . Conclusion: Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m 2 , suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452-463. |
| Databáze: | MEDLINE |
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