Balkam Colleen B, Parks Nancy L, Fricka Kevin B
Anderson Orthopaedic Research Institute, Alexandria, VA, USA.
Anderson Clinic Post-Graduate Medical Education Foundation, Alexandria, VA, USA.
Arthroplast Today. 2025 Aug 5;34:101785. doi: 10.1016/j.artd.2025.101785. eCollection 2025 Aug.
Over 35% of the US population is obese, leading to earlier arthroplasty needs, increased comorbidities, surgical challenges, and higher complication and revision rates. Concurrently, outpatient hip and knee arthroplasty procedures are increasing. This study aimed to evaluate early complication rates of same-day discharge (SDD) arthroplasty in severely obese patients (body mass index [BMI] ≥40).
We retrospectively reviewed 15,133 primary hip or knee arthroplasty patients from 2015 to 2022, divided into four groups: obese SDD (n = 247), obese overnight (n = 1123), nonobese SDD (n = 5184), and nonobese overnight (n = 8579).
Obese SDD patients were significantly younger than obese overnight patients (mean age 58.8 vs. 62.9 years, < .0001), and obese females were more likely to stay overnight. The average BMI of obese SDD patients was slightly lower (43.3 vs. 44.8). Crucially, the obese SDD group did not show higher rates of intraoperative or 90-day complications compared to nonobese SDD patients and had impressive improvements in patient-reported outcomes. Obese patients in both groups (regardless of discharge status) exhibited slightly higher early revision rates than nonobese patients, as expected.
Our findings suggest that SDD for hip and knee arthroplasty can be safely performed in severely obese patients (BMI > 40) without significantly increasing early surgical complications. However, the inherently higher revision rate for high BMI patients undergoing joint replacement remains, irrespective of discharge timing.
超过35%的美国人口肥胖，这导致关节置换手术需求提前、合并症增加、手术挑战增多以及并发症和翻修率升高。与此同时，门诊髋关节和膝关节置换手术正在增加。本研究旨在评估重度肥胖患者（体重指数[BMI]≥40）当日出院（SDD）关节置换术的早期并发症发生率。
我们回顾性分析了2015年至2022年的15133例初次髋关节或膝关节置换术患者，分为四组：肥胖当日出院组（n = 247）、肥胖过夜组（n = 1123）、非肥胖当日出院组（n = 5184）和非肥胖过夜组（n = 8579）。
肥胖当日出院患者比肥胖过夜患者显著年轻（平均年龄58.8岁对62.9岁，P <.0001），肥胖女性更有可能过夜。肥胖当日出院患者的平均BMI略低（43.3对44.8）。至关重要的是，与非肥胖当日出院患者相比，肥胖当日出院组术中或90天并发症发生率并未更高，且患者报告的结局有显著改善。正如预期的那样，两组肥胖患者（无论出院状态如何）的早期翻修率均略高于非肥胖患者。
我们的研究结果表明，对于重度肥胖患者（BMI>40），髋关节和膝关节置换术的当日出院可以安全进行，而不会显著增加早期手术并发症。然而，无论出院时间如何，接受关节置换的高BMI患者固有的较高翻修率仍然存在。
