Advertisement

The Effect of Obesity and Increasing Age on Operative Time and Length of Stay in Primary Hip and Knee Arthroplasty

      Abstract

      We retrospectively reviewed 589 patients undergoing lower-limb arthroplasty, recording age, body mass index (BMI) and co-morbidities. The effect of these on operative duration and length of stay (LOS) was analysed. For a 1 point increase in BMI we expect LOS to increase by a factor of 2.9% and mean theatre time to increase by 1.46 minutes. For a 1-year increase in age, we expect LOS to increase by a factor of 1.2%. We have calculated the extra financial costs associated. The current reimbursement system underestimates the financial impact of BMI and age. The results have been used to produce a chart that allows prediction of LOS following lower limb arthroplasty based on BMI and age. These data are of use in planning operating lists.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tukker A.
        • Visscher T.L.
        • Picavet H.S.
        Overweight and health problems of the lower extremities: osteoarthritis, pain and disability.
        Public Health Nutr. 2009; 12: 359
        • Gillespie G.N.
        • Porteous A.J.
        Obesity and knee arthroplasty.
        Knee. 2007; 14 ([Epub 2006 Dec 22]): 81
        • Fehring T.K.
        • Odum S.M.
        • Griffin W.L.
        • et al.
        The obesity epidemic: its effect on total joint arthroplasty.
        J Arthroplasty. 2007; 22: 71
        • Coombes R.
        Rationing of joint replacements raises fears of further cuts.
        BMJ. 2005; 331: 1290
        • Patel V.P.
        • Walsh M.
        • Sehgal B.
        • et al.
        Factors associated with prolonged wound drainage after primary total hip and knee arthroplasty.
        J Bone Joint Surg Am. 2007; 89: 33
      1. National Joint Registry for England and Wales 9th Annual Report. 2012
        • Finer N.
        Rationing joint replacements—trust’s decision seems to be based on prejudice or attributing blame.
        Br Med J. 2005; 331: 1472
        • Chee Y.H.
        • Teoh K.H.
        • Sabnis B.M.
        • et al.
        Total hip replacement in morbidly obese patients with osteoarthritis: results of a prospectively matched study.
        J Bone Joint Surg (Br). 2010; 92: 1066
        • Davis A.M.
        • Wood A.M.
        • Keenan A.C.
        • et al.
        Does body mass index affect clinical outcome post-operatively and at five years after primary unilateral total hip replacement performed for osteoarthritis? A multivariate analysis of prospective data.
        J Bone Joint Surg (Br). 2011; 93: 1178
        • Dowsey M.M.
        • Liew D.
        • Stoney J.D.
        • et al.
        The impact of pre-operative obesity on weight change and outcome in total knee replacement: a prospective study of 529 consecutive patients.
        J Bone Joint Surg (Br). 2010; 92: 513
        • Kim S.H.
        Morbid obesity and excessive hospital resource consumption for unilateral primary hip and knee arthroplasty.
        J Arthroplasty. 2010; 25: 1258
        • Dowsey M.M.
        • Liew D.
        • Choong P.F.
        Economic burden of obesity in primary total knee arthroplasty.
        Arthritis Care Res (Hoboken). 2011; 63: 1375
        • Cavenaghi F.
        • Cerri C.
        • Panella L.
        Association of hemoglobin levels, acute hemoglobin decrease and age with rehabilitation outcomes after total hip and knee replacement.
        Eur J Phys Rehabil Med. 2009; 45: 319
        • Foote J.
        • Panchoo K.
        • Blair P.
        • et al.
        Length of stay following primary total hip replacement.
        Ann R Coll Surg Engl. 2009; 91: 500
        • Husted H.
        • Holm G.
        • Jacobsen S.
        Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients.
        Acta Orthop. 2008; 79: 168
        • Smith I.D.
        • Elton R.
        • Ballantyne J.A.
        • et al.
        Pre-operative predictors of the length of hospital stay in total knee replacement.
        J Bone Joint Surg (Br). 2008; 90
        • Andrew J.G.
        • Palan J.
        • Kurup H.V.
        • et al.
        Obesity in total hip replacement.
        Joint Surg Br. 2008; 90: 424
        • Bennett D.
        • Gibson D.
        • O’Brien S.
        • et al.
        Hip arthroplasty in morbidly obese patients—intra-operative and short term outcomes.
        Hip Int. 2010; 20: 75
        • Vincent H.K.
        • Vincent K.R.
        Obesity and inpatient rehabilitation outcomes following knee arthroplasty: a multicenter study.
        Obesity (Silver Spring). 2008; 16: 130
        • Vincent H.K.
        • Weng J.P.
        • Vincent K.R.
        Effect of obesity on inpatient rehabilitation outcomes after total hip arthroplasty.
        Obesity (Silver Spring). 2007; 15: 522
        • Batsis J.A.
        • Naessens J.M.
        • Keegan M.T.
        • et al.
        Impact of body mass on hospital resource use in total hip arthroplasty.
        Public Health Nutr. 2009; 12: 1122
        • Batsis J.A.
        • Naessens J.M.
        • Keegan M.T.
        • et al.
        Body mass index and the impact on hospital resource use in patients undergoing total knee arthroplasty.
        J Arthroplasty. 2010; 25: 1250
        • Core Team R.
        R: a language and environment for statistical computing.
        3-900051-07-0 R Foundation for Statistical Computing, Vienna, Austria2012 ([URL http://www.R-project.org/])
        • Namba R.S.
        • Paxton L.
        • Fithian D.C.
        • et al.
        Obesity and perioperative morbidity in total hip and total knee arthroplasty patients.
        J Arthroplasty. 2005; 20: 46
        • Vazquez-Vela Johnson G.
        • Worland R.L.
        • Keenan J.
        • et al.
        Patient demographics as a predictor of the ten-year survival rate in primary total knee replacement.
        J Bone Joint Surg (Br). 2003; 85: 52
        • Sadr Azodi O.
        • Bellocco R.
        • Eriksson K.
        • et al.
        The impact of tobacco use and body mass index on the length of stay in hospital and the risk of post-operative complications among patients undergoing total hip replacement.
        J Bone Joint Surg (Br). 2006; 88: 1316
        • Foran J.R.
        • Mont M.A.
        • Etienne G.
        • et al.
        The outcome of total knee arthroplasty in obese patients.
        J Bone Joint Surg Am. 2004; 86-A: 1609
        • McKellop H.A.
        • Campbell P.
        • Park S.H.
        • et al.
        The origin of submicron polyethylene wear debris in total hip arthroplasty.
        Clin Orthop Relat Res. 1995; 311: 3
        • Haverkamp D.
        • Klinkenbijl M.N.
        • Somford M.P.
        • et al.
        Obesity in total hip arthroplasty—does it really matter? A meta-analysis.
        Acta Orthop. 2011; 82: 417
        • Moran M.
        • Walmsley P.
        • Gray A.
        • et al.
        Does body mass index affect the early outcome of primary total hip arthroplasty?.
        J Arthroplasty. 2005; 20: 866
        • Amin A.K.
        • Patton J.T.
        • Cook R.E.
        • et al.
        Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis?.
        J Bone Joint Surg (Br). 2006; 88: 335
        • Ethgen O.
        • Bruyère O.
        • Richy F.
        • et al.
        Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature.
        J Bone Joint Surg Am. 2004; 86-A: 963
        • Hawker G.
        • Wright J.
        • Coyte P.
        • et al.
        Health-related quality of life after knee replacement.
        J Bone Joint Surg Am. 1998; 80: 163
        • Wang T.
        • Ackland T.
        • Hall S.
        • et al.
        Functional recovery and timing of hospital discharge after primary total hip arthroplasty.
        Aust N Z J Surg. 1998; 68: 580
        • Jørgensen C.C.
        • Kehlet H.
        Role of patient characteristics for fast-track hip and knee arthroplasty.
        Br J Anaesth. 2013 Jun; 110: 972-980https://doi.org/10.1093/bja/aes505
        • Huddleston J.I.
        • Wang Y.
        • Uquillas C.
        • et al.
        Age and obesity are risk factors for adverse events after total hip arthroplasty.
        Clin Orthop Relat Res. 2012; 470: 490