Effect of BMI on Postoperative Morbidities of Orthopaedic Procedures

Study Overview
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Brief Summary
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Obesity is associated with poor surgical outcome and complications. The literature does not provide a comprehensive view on the effect of body mass index (BMI) on perioperative outcomes in orthopedic surgeries. Therefore, we aim to determine the effect of BMI on 30-day perioperative outcomes in patients undergoing the first 25 most commonly performed orthopedic surgeries using a retrospective cohort study design. The knowledge of the effect of BMI on orthopedic surgeries will improve the knowledge of surgeons about the expected morbidities.

Detailed Description
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Obesity is associated with poor surgical outcome and complications. The literature does not provide a comprehensive view on the effect of body mass index (BMI) on perioperative outcomes in orthopedic surgeries. Therefore, we aim to determine the procedure specific, independent-effect of BMI on 30-day perioperative outcomes in patients undergoing the first 25 most commonly performed orthopedic surgeries. The study is a retrospective cohort study. The subjects will be the individuals undergoing one of first 25 most commonly performed orthopedic surgeries, whose information is derived form the de-identified patients' data collected through the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome will be composite post-operative morbidity. Specific morbidities will also be evaluated including cardiovascular, vascular and renal complications, length-of-stay (LOS), and the need for re-intervention and readmission, as well as 30-day mortality. Descriptive statistics and multivariable regression models will assess the independent-effect of BMI on outcomes. The knowledge of the effect of BMI on orthopedic surgeries will improve the knowledge of surgeons about the expected morbidities. The surgeon will be able to better counsel obese patients and devise a better surgical plan to prevent or deal with the expected outcomes.

Official Title
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The Effect Of BMI On Thirty-day Postoperative Morbidities And Mortality For The Most Common Orthopaedic Procedures

Conditions
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Orthopedic Procedures, Obesity

Intervention / Treatment
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* Procedure: Orthopaedic surgery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: The inclusion and exclusion criteria are the same as that of ACS-NSQIP database. All patients who have undergone any of the 25 most common orthopedic procedures as primary procedure as identified through the CPT codes Exclusion Criteria: All patients whose BMI was not reported

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| underweight<br>patients who underwent one of the 25 common orthopaedic surgeries and have a body mass index (BMI) of <18.5kg/m2 | Procedure: Orthopaedic surgery<br>* One of the 25 most common orthopedic surgeries reported in the database which are the following as per surgical types: spine surgery (CPT codes 63030, 63047, 22612, 22551 or 22558), trauma (CPT codes 27236, 27125, 27244, 27814, or 27792), sports medicine injuries (CPT codes 29881, 29827, 29880, 29888, 29826, 29877, 29807, or 23412), or joint arthroplasty (CPT codes 27447, 27130, 23472, 27487, 27134, 27446, or 27486).<br>|
| normal-weight<br>patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 18.5kg/m2 and 24.9kg/m2 | Procedure: Orthopaedic surgery<br>* One of the 25 most common orthopedic surgeries reported in the database which are the following as per surgical types: spine surgery (CPT codes 63030, 63047, 22612, 22551 or 22558), trauma (CPT codes 27236, 27125, 27244, 27814, or 27792), sports medicine injuries (CPT codes 29881, 29827, 29880, 29888, 29826, 29877, 29807, or 23412), or joint arthroplasty (CPT codes 27447, 27130, 23472, 27487, 27134, 27446, or 27486).<br>|
| overweight<br>patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 25kg/m2 and 29.9kg/m2 | Procedure: Orthopaedic surgery<br>* One of the 25 most common orthopedic surgeries reported in the database which are the following as per surgical types: spine surgery (CPT codes 63030, 63047, 22612, 22551 or 22558), trauma (CPT codes 27236, 27125, 27244, 27814, or 27792), sports medicine injuries (CPT codes 29881, 29827, 29880, 29888, 29826, 29877, 29807, or 23412), or joint arthroplasty (CPT codes 27447, 27130, 23472, 27487, 27134, 27446, or 27486).<br>|
| mildly obese<br>patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 30kg/m2 and 34.9kg/m2 | Procedure: Orthopaedic surgery<br>* One of the 25 most common orthopedic surgeries reported in the database which are the following as per surgical types: spine surgery (CPT codes 63030, 63047, 22612, 22551 or 22558), trauma (CPT codes 27236, 27125, 27244, 27814, or 27792), sports medicine injuries (CPT codes 29881, 29827, 29880, 29888, 29826, 29877, 29807, or 23412), or joint arthroplasty (CPT codes 27447, 27130, 23472, 27487, 27134, 27446, or 27486).<br>|
| moderately-to-severely obese<br>patients who underwent one of the 25 common orthopaedic surgeries and have a BMI ≥35kg/m2 | Procedure: Orthopaedic surgery<br>* One of the 25 most common orthopedic surgeries reported in the database which are the following as per surgical types: spine surgery (CPT codes 63030, 63047, 22612, 22551 or 22558), trauma (CPT codes 27236, 27125, 27244, 27814, or 27792), sports medicine injuries (CPT codes 29881, 29827, 29880, 29888, 29826, 29877, 29807, or 23412), or joint arthroplasty (CPT codes 27447, 27130, 23472, 27487, 27134, 27446, or 27486).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Composite morbidity | Composite morbidity is defined as the presence of any of the specific morbidities during the 30-days following surgery as recorded in the ACS-NSQIP database. The odds ratio of composite morbidity for each BMI group will be calculated as compared to normal-weight group. | within the 30 days following the surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality | odds ratio of mortality within the 30-days following the surgery for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| wound | odds ratio of specific morbidity of surgical wound for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| cardiac | specific morbidity of cardiac complication for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| respiratory | odds ratio of specific morbidity of respiratory complication | within the 30 days following the surgery | 
| urinary | odds ratio of specific morbidity of urinary complication for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| neurological | odds ratio of specific morbidity of neurological (CNS) complication for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| thromboembolism | odds ratio of specific morbidity of thromboembolism for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| sepsis | odds ratio of specific morbidity of sepsis for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| bleeding | odds ratio of bleeding or transfusion need for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 
| Re-op | odds ratio of need for re-admission/re-operation for each BMI group as compared to normal-weight group | within the 30 days following the surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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BMI, weight, orthopedic surgery, Post-Op Complication