Nutritional Counseling Program for Morbidly Obese Patients Enables Weight Optimization for Safe Total Joint Arthroplasty
Autor: | Ciara N Beck, Max Lingamfelter, Alvin Ong, Fabio Orozco, Zachary D. Post, Danielle Y. Ponzio, Michael F Harrer |
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Rok vydání: | 2018 |
Předmět: |
Adult
Counseling Male medicine.medical_specialty medicine.medical_treatment Population Periprosthetic Body Mass Index 03 medical and health sciences 0302 clinical medicine Postoperative Complications Weight loss Internal medicine Osteoarthritis Preoperative Care Weight Loss Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Risk factor Arthroplasty Replacement education Aged Retrospective Studies Aged 80 and over 030222 orthopedics education.field_of_study business.industry Middle Aged medicine.disease Arthroplasty Obesity Obesity Morbid Treatment Outcome Orthopedic surgery Surgery Female Nutrition Therapy medicine.symptom business Body mass index Follow-Up Studies |
Zdroj: | Orthopedics. 43(4) |
ISSN: | 1938-2367 |
Popis: | Obesity affects one-third of total joint arthroplasty (TJA) patients and is the most common modifiable risk factor for increased complications in the TJA population. The authors' institution implemented a body mass index (BMI) cutoff of 40 kg/m 2 to define appropriate TJA candidates. Patients above the cutoff were referred for nutritional counseling. The study objective was to evaluate the efficacy of this protocol in optimizing patient BMI for safe and successful TJA. Between 2016 and 2018, the authors examined 133 patients (mean age, 62.6 years) with a BMI greater than 40 kg/m 2 seeking TJA (94 knee, 39 hip) seen by an arthroplasty surgeon and then a dietitian. Outcomes included weight loss, change in BMI, duration of counseling, and surgical status. For postoperative patients, 90-day complications were recorded. A total of 102 (92%) patients achieved weight loss during a mean 154 days (range, 8–601 days). Patients lost a mean of 17 lb, lowering their BMI by 2.7 points (range, +6.3 to −17.7 points). Twenty-two patients discontinued nutritional counseling after 1 visit, most commonly secondary to cost when not covered by insurance. Seventy-one patients successfully underwent TJA, representing 64% of those patients who participated in nutritional counseling. Complications included delayed wound healing (n=2), periprosthetic fracture (n=2), infection (n=1), cellulitis (n=1), and peroneal nerve palsy (n=1). Surgeons must actively counsel obese patients about weight optimization as part of the preoperative standard of care. Nutritional counseling with a dietitian and follow-up with the surgeon translated to safe and successful TJA in a majority of patients. [ Orthopedics . 2020;43(4):e316–e322.] |
Databáze: | OpenAIRE |
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