Abstract
Introduction
Obesity is a direct contributor to degenerative joint disease, and as the prevalence of obesity increases globally it is likely that more overweight patients will present for hip replacement surgery. There are reports that overweight patients in the UK's National Health Service, typically with a Body Mass Index (BMI) over 30 (BMI 30–39 obese, BMI≥40 morbidly obese), are being denied operations on the premise that they are at risk of significant complications. Enhanced Recovery Programmes (ERP) are designed to enable patients to recover quickly and return home safely within a few days. The aim of this study was to compare the outcome of hip replacements in obese and non-obese patients enrolled in our ERP.
Methods
We prospectively studied 350 patients who underwent primary and revision total hip replacements and were treated through our ERP form March 2010 to January 2011. The mean age was 68 (range 23–92 years). 130 patients (37%) were considered obese with a BMI of >30. 11 patients (3%) were considered morbidly obese with a BMI >40. They were age & sex-matched with the non-obese patients. Outcomes measured included: Length of stay, wound complications (including surgical site infections), deep vein thrombosis and blood transfusion requirements. Data was collected to 42 days following discharge.
Results
There was no significant difference in the length of stay between the obese (BMI >30) and non-obese (BMI<30) groups; 4.3 days (median 4) and 4.1 days (median 4) respectively. Mean length of stay in the morbidly obese group (BMI≥40) was interestingly, 3.4 days (median 3). 12 patients (9%) in the obese group experienced non-infective wound complications including oozing and haematoma formation compared to 15 patients (7%) of the non-obese group. One confirmed DVT was identified in the morbidly obese group (BMI 41). There were no significant differences in surgical site infections, blood transfusion requirements, or other patient-reported outcome measures at 42 days.
Conclusion
Body mass index (BMI) did not affect the early post-operative outcome of hip replacements in patients enrolled in the ERP. Based on the evidence provided by this study, we would continue to offer hip replacement surgery irrespective of body mass index.
