Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA.
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
J Arthroplasty. 2021 Aug;36(8):2708-2715.e1. doi: 10.1016/j.arth.2021.02.078. Epub 2021 Mar 6.
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).
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.
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.
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.
肥胖是全关节置换术（TJA）后并发症的一个风险因素。本研究分析了个体外科医生的人口统计学特征、财务状况和其他因素对 TJA 患者候选资格的影响，其依据是体重指数（BMI）。
美国髋关节和膝关节外科医生协会研究委员会批准了一项 21 个问题的调查，供其成员分发。客观问题询问外科医生或医院提供 TJA 的 BMI 阈值。主观问题询问医生在 TJA 前讨论肥胖、减重手术和减肥、保险和年龄等话题的舒适度。
对于 TJA 手术，49.9%的外科医生有 40 的 BMI 截止值，24.5%有 45 的 BMI 截止值，8.3%有 50 的 BMI 截止值。在 BMI 截止值为 40 时，23.8%的外科医生认为他们的患者数量会受到不利影响，而在 BMI 截止值为 35 时，50%的外科医生认为他们的患者数量会受到不利影响。外科医生更不愿意为病态肥胖患者进行全髋关节置换术，而不是全膝关节置换术（P =.037）。与所有其他实践环境相比，明显更多的学术外科医生对全髋关节置换术（P =.003）或全膝关节置换术（P <.001）没有截止值。
影响外科医生提供选择性 TJA 的 BMI 截止值的因素有很多，包括不良结果、医院阈值、财务考虑因素和患者的健康状况。应进一步开展工作，尽量减少 TJA 相关风险，同时为病态肥胖患者提供尽可能好的护理。
