Abstract
Background:
The rising number of morbidly obese patients may have significant consequences on the health care system. It may alter the effectiveness, safety as well as cost of certain surgical procedures. Reverse shoulder arthroplasty (RSA) is rapidly gaining in popularity. We investigated the effect of morbid obesity on outcomes, complications, disposition and cost in morbidly obese patients undergoing RSA in a 1: 3 case control series.
Methods:
Our joint registry was searched for all patients undergoing primary RSA (excluding fractures) with a minimum of 24 months follow-up from 2003–2010; 21 patients with Body Mass Index (BMI) > 35 were identified (follow-up 45 ± 16 months, 17 females and 4 males, age 69 ± 7) and compared to 63 matched control patients with BMI<30 (follow-up 48 ± 20, 50 females, age 71 ± 6). Outcome data was obtained pre- and postoperatively. Patients' Charlson-Deyo comorbidity index (CDI), total comorbidities, operative time, blood loss (EBL), hospitalization length, disposition, cost and complications were recorded.
Results:
There were significant (p < 0.05 for all) and comparable improvements in clinical outcomes, i.e. ASES 32→69 versus 40→78) and range-of-motion (i.e. elevation 61°→140° versus 74°→153°). Obese patients had less notching (1/21 versus 5/63, p = 0.007). Obese patients had more total comorbidities excluding obesity (6 versus 4, p = 0.001), higher CDI (2 versus 1, p = 0.025) and higher rates of obstructive sleep apnea (48% versus 3%, p = 0.0001). They had longer operative time by 13 minutes (p = 0.014) and higher EBL by 40 ml (p = 0.008). Length of stay was similar (3.1 versus 2.6 days, p = 0.21) but a 6-fold higher rate of discharge to facilities (6/21 versus 3/63, p = 0.007) and a higher readmission rate (2 versus 0, p = 0.06) was seen in obese patients. Hospital cost was higher by $2,958.00 (p = 0.02). Major (n = 4 versus 8) and minor complication rates (n = 3 versus 14) were similar (p = 0.479 and 0.440, respectively). No intraoperative complications or mechanical device failures were noted in either group.
Conclusions:
RSA was as safe and effective in morbidly obese patients, but an increased cost, disposition to facilities and needs after discharge was observed.
