PROGNOSTIC FACTORS (BMI)
Strong evidence suggests that obese patients with glenohumeral osteoarthritis do not experience an increase in the rate of early post-operative complications

Rationale

Several high-quality studies have addressed BMI as a risk factor for early postoperative complications with none demonstrating significant differences with non-obese patients undergoing shoulder arthroplasty for glenohumeral osteoarthritis.

Bernstein D et al (2017) utilized a logistical regression model of data from the America College of Surgeons National Surgical Quality Improvement Program (NSQIP) to identify factors associated with increased risk of adverse events and re-admissions within 30 days of surgery. BMI was not found to predict an increased risk of these complications.

Chalmers et al (2014) failed to demonstrate an increase in complication rates, transfusion rates, intra-operative blood loss or surgical time based on BMI. However, a post-hoc analysis by the authors suggested that this study was underpowered to assess this association.

Jiang et al (2016) again queried the NSQIP database and found that while surgical time was increased for patients with greater BMI, 30-day complication and re-admission rates were not increased.

Strength of Evidence (quality of evidence): Strong

 

Benefits & Harms:

There is benefit in providing access to shoulder arthroplasty to obese patients as an option for treatment of glenohumeral osteoarthritis in face of the lack of increase in early postoperative complications.

 

Cost Effectiveness/Resource Utilization:

Considerable resources can be expended in attempts to modify high BMI to improve surgical risk. Other significant health benefits from treating obesity notwithstanding, shoulder arthroplasty for glenohumeral osteoarthritis appears not to be affected by BMI in early complication rates.

 

Future Research:

While early postoperative complication rates have not been demonstrated to be increased in obese patients undergoing shoulder arthroplasty for glenohumeral arthritis, the effect of BMI on other factors such as long-term complications (e.g. late infection, prosthetic loosening, dislocation, rotator cuff tear) and pain and functional outcomes remain to be demonstrated in high quality studies.

 


LEARN MORE ABOUT AAOS

The Future of OrthoGuidelines

FIND OUT MORE

The OrthoGuidelines Process