AAOS: Underweight status increases shoulder arthroplasty complications

(HealthDay)—Underweight patients have a high number of adverse events and postoperative infections after total shoulder arthroplasty, even compared with super morbidly obese patients, according to a study presented at the annual meeting of the American Academy of Orthopaedic Surgeons, held from March 12 to 16 in Las Vegas.

Taylor Ottesen, of the Yale School of Medicine in New Haven, Connecticut, and colleagues evaluated data on 15,725 patients from the National Surgical Quality Improvement Program database who underwent total shoulder arthroplasty from 2005 to 2016. The authors sought to evaluate the relationship between body mass index (BMI) and adverse events after total shoulder arthroplasty.

The researchers categorized patients according to their BMI: underweight (<18.5 kg/m²), normal weight (18.5 to 24.9 kg/m²), overweight (25 to 29.9 kg/m²), obese (30 to 40 kg/m²), morbidly obese (40 to 50 kg/m²), and super morbidly obese (>50 kg/m²). The investigators found that compared with patients who were normal weight, those who were underweight were more apt to have any adverse event (odds ratio [OR], 2.30), a major adverse event (OR, 3.32), or major postoperative infection (OR, 2.97). Even patients in the super morbidly obese group were less likely to have any adverse event (OR, 0.88), a major adverse event (OR, 0.39), or postoperative infection (OR, 0.52). Compared with patients in all other categories, patients who were underweight were also more likely to undergo readmission within 30 days of surgery.

"Underweight patients are an extremely at-risk population who have previously not received significant focus," the authors write. "Physicians and health care systems should give additional consideration to this fragile population, as they often already do for those at the other end of the BMI spectrum."

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