Can Patient Selection Explain the Obesity Paradox in Orthopaedic Hip Surgery? An Analysis of the ACS-NSQIP Registry

Clinical Orthopaedics and Related Research
Joyce C ZhangPeter Cram

Abstract

The "obesity paradox" is a phenomenon described in prior research in which patients who are obese have been shown to have lower postoperative mortality and morbidity compared with normal-weight individuals. The paradox is that clinical experience suggests that obesity is a risk factor for difficult wound healing and adverse cardiovascular outcomes. We suspect that the obesity paradox may reflect selection bias in which only the healthiest patients who are obese are offered surgery, whereas nonobese surgical patients are comprised of both healthy and unhealthy individuals. We questioned whether the obesity paradox (decreased mortality for patients who are obese) would be present in nonurgent hip surgery in which patients can be carefully selected for surgery but absent in urgent hip surgery where patient selection is minimized. (1) What is the association between obesity and postoperative mortality in urgent and nonurgent hip surgery? (2) How is obesity associated with individual postoperative complications in urgent and nonurgent hip surgery? (3) How is underweight status associated with postoperative mortality and complications in urgent and nonurgent hip surgery? We used 2011 to 2014 data from the American College of Surgeons...Continue Reading

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Citations

Sep 4, 2019·The Journal of the American Academy of Orthopaedic Surgeons·Jared WarrenNicolas S Piuzzi
Apr 7, 2020·International Anesthesiology Clinics·Detlef Obal, Anupama Wadhwa
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Jan 13, 2022·Orthopedics·Nishant SunejaAhmed Saleh

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Methods Mentioned

BETA
coronary artery bypass
partial hip arthroplasty

Software Mentioned

R

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