Complications of Morbid Obesity in Total Joint Arthroplasty: Risk Stratification Based on BMI

This study stratifies complication risk in primary total joint arthroplasty (TJA) based on body mass index (BMI). Demographics, co-morbidities, perioperative variables, and complications were reviewed for 22,808 patients. Chi-squared, one-way ANOVA, univariate and multivariable regression analysis were performed. Increasing BMI led to an increase (P < 0.05) in combined complications, acute kidney injury (AKI), cardiac arrest (CA), reintubation, reoperation, and superficial infection (SI). Univariate analysis for BMI > 40 revealed an increase in combined complications (15.21-vs-17.40%), AKI (1.93-vs-3.87%), CA (0.22-vs-0.57%), reintubation (0.47-vs-0.95%), reoperation (2.36-vs-3.37%), and SI (0.82-vs-1.65%). Multivariable regression showed BMI > 40 as an independent predictor for combined complications (OR = 1.18), AKI (OR = 1.79), CA (OR = 3.94), reintubation (OR = 2.56), reoperation (OR = 1.44), and SI (OR = 2.11). Morbid obesity confers increased risk for complications in TJA.