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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.
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| underweight | patients who underwent one of the 25 common orthopaedic surgeries and have a body mass index (BMI) of <18.5kg/m2 |
| |
| normal-weight | patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 18.5kg/m2 and 24.9kg/m2 |
| |
| overweight | patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 25kg/m2 and 29.9kg/m2 |
| |
| mildly obese | patients who underwent one of the 25 common orthopaedic surgeries and have a BMI between 30kg/m2 and 34.9kg/m2 |
| |
| moderately-to-severely obese | patients who underwent one of the 25 common orthopaedic surgeries and have a BMI ≥35kg/m2 |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Orthopaedic surgery | Procedure | 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). |
| 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 |
| 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 |
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Inclusion Criteria:
Exclusion Criteria:
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Representative of the population from ACS-NSQIP
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| Name | Affiliation | Role |
|---|---|---|
| Muhyeddine Al-Taki | American University of Beirut Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| American University of Beirut Medical Center | Beirut | 11-236 | Lebanon |
Only the de-identified and coded data are available through the registry and we do not plan of sharing any individual data
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| ID | Term |
|---|---|
| D009765 | Obesity |
| D001835 | Body Weight |
| D011183 | Postoperative Complications |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| 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 |
| D012816 |
| Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |