PMID- 38113913
OWN - NLM
STAT- MEDLINE
DCOM- 20240514
LR  - 20240514
IS  - 1938-2480 (Electronic)
IS  - 1538-8506 (Linking)
VI  - 37
IP  - 7
DP  - 2024 Jun
TI  - Preoperative and Postoperative Weight Change has Minimal Influence on Health Care 
      Utilization and Patient-Reported Outcomes Following Total Knee Arthroplasty.
PG  - 545-554
LID - 10.1055/a-2232-7657 [doi]
AB  - As obesity becomes more prevalent, more patients are at risk of lower extremity 
      osteoarthritis and subsequent total knee arthroplasty (TKA). This study aimed to 
      test (1) the association of preoperative weight change with health care 
      utilization and (2) the association of pre- and postoperative weight changes with 
      failure to achieve satisfaction and minimal clinically important difference 
      (MCID) in Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and 
      function (KOOS-PS) 1 year after TKA. Prospectively collected monocentric data on 
      patients who underwent primary TKA were retrospectively reviewed. Multivariable 
      logistic regression assessed the influence of BMI and weight change on outcomes 
      while controlling for confounding variables. Outcomes included prolonged length 
      of stay (LOS >3 days), nonhome discharge, 90-day readmission rate, satisfaction, 
      and achievement of MCID for KOOS-Pain and KOOS-PS. Preoperative weight change had 
      no impact on prolonged LOS (gain, p = 0.173; loss, p = 0.599). Preoperative 
      weight loss was associated with increased risk of nonhome discharge (odds ratio 
      [OR]: 1.47, p = 0.003). There was also increased risk of 90-day readmission with 
      preoperative weight gain (OR: 1.27, p = 0.047) and decreased risk with weight 
      loss (OR: 0.73, p = 0.033). There was increased risk of nonhome discharge with 
      obesity class II (OR: 1.6, p = 0.016) and III (OR: 2.21, p < 0.001). Weight 
      change was not associated with failure to achieve satisfaction, MCID in 
      KOOS-Pain, or MCID in KOOS-PS. Obesity class III patients had decreased risk of 
      failure to reach MCID in KOOS-Pain (OR: 0.43, p = 0.005) and KOOS-PS (OR: 0.7, 
      p = 0.007). Overall, pre- and postoperative weight change has little impact on 
      the achievement of satisfaction and clinically relevant differences in pain and 
      function at 1 year. However, preoperative weight gain was associated with a 
      higher risk of 90-day readmissions after TKA. Furthermore, patients categorized 
      in Class III obesity were at increased risk of nonhome discharge but experienced 
      a greater likelihood of achieving MCID in KOOS-Pain and KOOS-PS. Our results 
      raise awareness of the dangers of using weight changes and BMI alone as a measure 
      of TKA eligibility.
CI  - Thieme. All rights reserved.
FAU - Tidd, Joshua L
AU  - Tidd JL
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
AD  - College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio.
FAU - Huffman, Nickelas
AU  - Huffman N
AUID- ORCID: 0009-0002-0610-3919
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
FAU - Oyem, Precious C
AU  - Oyem PC
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
AD  - Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio.
FAU - Pasqualini, Ignacio
AU  - Pasqualini I
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
FAU - Hadad, Matthew J
AU  - Hadad MJ
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
FAU - Klika, Alison K
AU  - Klika AK
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
FAU - Deren, Matthew E
AU  - Deren ME
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
FAU - Piuzzi, Nicolas S
AU  - Piuzzi NS
AUID- ORCID: 0000-0003-3007-7538
AD  - Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
LA  - eng
PT  - Journal Article
DEP - 20231219
PL  - Germany
TA  - J Knee Surg
JT  - The journal of knee surgery
JID - 101137599
SB  - IM
MH  - Humans
MH  - *Arthroplasty, Replacement, Knee
MH  - Male
MH  - Female
MH  - Aged
MH  - *Patient Reported Outcome Measures
MH  - Retrospective Studies
MH  - Middle Aged
MH  - Osteoarthritis, Knee/surgery
MH  - Patient Acceptance of Health Care/statistics & numerical data
MH  - Patient Satisfaction
MH  - Patient Readmission/statistics & numerical data
MH  - Weight Loss
MH  - Preoperative Period
MH  - Length of Stay
MH  - Postoperative Period
MH  - Weight Gain
COIS- None declared.
EDAT- 2023/12/20 06:42
MHDA- 2024/05/15 05:47
CRDT- 2023/12/19 18:53
PHST- 2024/05/15 05:47 [medline]
PHST- 2023/12/20 06:42 [pubmed]
PHST- 2023/12/19 18:53 [entrez]
AID - 10.1055/a-2232-7657 [doi]
PST - ppublish
SO  - J Knee Surg. 2024 Jun;37(7):545-554. doi: 10.1055/a-2232-7657. Epub 2023 Dec 19.