Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery

Abstract

Study objective: To determine whether obesity status is associated with perioperative complications, discharge outcomes and hospital length of stay in older surgical patients.

Design: Secondary analysis of five independent study cohorts (N = 1262).

Setting: An academic medical center between 2001 and 2017 in the United States.

Patients: Patients aged 65 years or older who were scheduled to undergo elective spine, knee, or hip surgery with an expected hospital stay of at least 2 days.

Measurements: Body mass index (BMI) was stratified as nonobese (BMI ≤ 30 kg/m²), obesity class 1 (30 kg/m² ≤ BMI < 35 kg/m²) or obesity class 2-3 (BMI ≥ 35 kg/m²). Primary outcomes included predefined intraoperative and postoperative complications, hospital length of stay (LOS), and discharge location. Univariate and multivariate logistic regression was performed.

Main results: Obesity status was not associated with intraoperative adverse events. However, obesity class 2-3 significantly increased the risk for postoperative complications (IRR 1.43, 95% CI 1.03-1.95, P = 0.03), hospital LOS (IRR 1.13, 95% CI 1.02-1.25, P = 0.02) and non-home discharge destination (OR 1.95, 95% CI 1.35-2.81, P < 0.001) after accounting for patient related factors and surgery type.

Conclusions: Obesity class 2-3 status has prognostic value in predicting an increased incidence of postoperative complications, increased hospital LOS, and non-home discharge location. These results have important clinical implications for preoperative informed consent and provide areas to target for care improvement for the older obese individual.

Keywords: Discharge; Obesity; Older adult; Outcomes.