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

Authors

William F. Sherman, Tulane University School of Medicine
Akshar H. Patel, Tulane University School of Medicine
Nisha N. Kale, Tulane University School of Medicine
Christina M. Freiberger, Tulane University School of Medicine
C. Lowry Barnes, University of Arkansas for Medical Sciences
Olivia C. Lee, LSU Health Sciences Center- New OrleansFollow

Document Type

Article

Publication Date

8-1-2021

Publication Title

Journal of Arthroplasty

Abstract

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.

First Page

2708

Last Page

2715.e1

PubMed ID

33865649

Volume

36

Issue

8

Publisher

Elsevier ; American Association of Hip and Knee Surgeons

Recommended Citation

Sherman, William F.; Patel, Akshar H.; Kale, Nisha N.; Freiberger, Christina M.; Barnes, C. Lowry; and Lee, Olivia C., "Surgeon Decision-Making for Individuals With Obesity When Indicating Total Joint Arthroplasty" (2021). School of Medicine Faculty Publications. 225.
https://digitalscholar.lsuhsc.edu/som_facpubs/225
10.1016/j.arth.2021.02.078