TY - JOUR
T1 - Risk of complications in patients who are obese following upper limb arthroplasty
T2 - A systematic review and meta-analysis
AU - Theodoulou, Annika
AU - Krishnan, Jeganath
AU - Aromataris, Edoardo
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: A systematic review was performed to investigate the impact of obesity on complications following total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA) and total elbow arthroplasty (TEA). Methods: Electronic databases and grey literature were searched for studies that evaluated the influence of obesity (Body Mass Index[BMI] ≥30 kg m2) on upper limb arthroplasty outcomes. Fifteen studies were identified, however only twelve reported predetermined outcomes. Unadjusted data was pooled in statistical meta-analysis where appropriate. Effect sizes were expressed as odds ratios (OR) for categorical data and weighted mean differences for continuous data. Results: Odds of infection increased with increasing BMI, from 2.37 (95%CI [1.653.41]) times in patients who were obese, to greater than five times (OR = 5.04; 95%CI [4.705.39]) in patients who were morbidly obese. Furthermore, patients who were obese or morbidly obese had 3.92 (95%CI [3.594.28]) to 5.46 (95%CI [4.916.07]) times greater odds of venous thromboembolism (VTE) compared to their non-obese counterparts, respectively. Conversely, obesity had no influence on the odds of urinary tract infection (OR = 0.88; 95%CI [0.481.61], or mortality (OR = 1.79; 95%CI [0.794.03]). TSA/RTSA patients who were obese experienced operations 10.00 minutes longer (95%CI [6.3113.69]) than patients with a BMI in the normal range, which increased to 12.48 min utes (95%CI [8.4016.55]) in patients with a BMI ≥ 35.0. Evidence examining the influence of obesity on blood transfusion was inconclusive, while minimal evidence was available on pneumonia. Conclusion: Surgeons should consider advising patients who are obese of the greater risk of VTE and infection when considering elective upper limb arthroplasty. However, noteworthy limitations surrounded the lack of information regarding prophylaxis regimes and BMI measurement tools used in included studies.
AB - Purpose: A systematic review was performed to investigate the impact of obesity on complications following total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA) and total elbow arthroplasty (TEA). Methods: Electronic databases and grey literature were searched for studies that evaluated the influence of obesity (Body Mass Index[BMI] ≥30 kg m2) on upper limb arthroplasty outcomes. Fifteen studies were identified, however only twelve reported predetermined outcomes. Unadjusted data was pooled in statistical meta-analysis where appropriate. Effect sizes were expressed as odds ratios (OR) for categorical data and weighted mean differences for continuous data. Results: Odds of infection increased with increasing BMI, from 2.37 (95%CI [1.653.41]) times in patients who were obese, to greater than five times (OR = 5.04; 95%CI [4.705.39]) in patients who were morbidly obese. Furthermore, patients who were obese or morbidly obese had 3.92 (95%CI [3.594.28]) to 5.46 (95%CI [4.916.07]) times greater odds of venous thromboembolism (VTE) compared to their non-obese counterparts, respectively. Conversely, obesity had no influence on the odds of urinary tract infection (OR = 0.88; 95%CI [0.481.61], or mortality (OR = 1.79; 95%CI [0.794.03]). TSA/RTSA patients who were obese experienced operations 10.00 minutes longer (95%CI [6.3113.69]) than patients with a BMI in the normal range, which increased to 12.48 min utes (95%CI [8.4016.55]) in patients with a BMI ≥ 35.0. Evidence examining the influence of obesity on blood transfusion was inconclusive, while minimal evidence was available on pneumonia. Conclusion: Surgeons should consider advising patients who are obese of the greater risk of VTE and infection when considering elective upper limb arthroplasty. However, noteworthy limitations surrounded the lack of information regarding prophylaxis regimes and BMI measurement tools used in included studies.
KW - BMI
KW - Complications
KW - Obesity
KW - Total elbow arthroplasty
KW - Total shoulder arthroplasty
KW - Upper limb arthroplasty
UR - http://www.scopus.com/inward/record.url?scp=85078985350&partnerID=8YFLogxK
U2 - 10.1016/j.orcp.2020.01.001
DO - 10.1016/j.orcp.2020.01.001
M3 - Review article
C2 - 32037275
AN - SCOPUS:85078985350
SN - 1871-403X
VL - 14
SP - 9
EP - 26
JO - Obesity Research and Clinical Practice
JF - Obesity Research and Clinical Practice
IS - 1
ER -
