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 Further research is needed to know why this happens and how to
prevent it, the study team writes in British Journal of Anaesthesia.
“I think there's been a lot of research on mortality and a lot of
research on complications, but not too much on how people actually
get back to how they perform at home,” lead author Dr. Timothy
Gaulton told Reuters Health.
“That was a part of the reason that we wanted to look at the
outcome, and in general obese patients,” said Gaulton, of the
Perelman School of Medicine at the University of Pennsylvania in
Philadelphia.
It’s important for potential joint surgery patients to know that in
some circumstances, because of their age, weight or preoperative
functional dependence, they may be at higher risk of getting worse
after surgery, he said in a telephone interview.
“It's something that needs to be considered both for the patient and
for the surgeon when they make this decision about moving forward
with getting a joint surgery,” he said.
The researchers studied 2,519 adults over age 61 who had joint
surgery for arthritis. About two-thirds of participants had joint
replacements. And 45 percent were obese, meaning they had a body
mass index (BMI) - a measure of weight relative to height - of 30 or
above at the time of their surgery.
Before surgery and during the following two years, participants were
asked if they had any physical, mental, emotional or memory problems
that affected their activities of daily living. These activities
could include things like getting out of bed, toileting, bathing and
eating. Needing help for any of these tasks was labeled as a
dependence disability.
About 22 percent of participants reported new or worsening
dependence approximately two years after their surgery - including
more than one in four obese patients and one in five non-obese
patients. Researchers calculated that obese joint surgery patients
had a 35 percent higher risk of dependence after surgery compared to
non-obese patients.
“We weren't surprised by the association between obesity and
outcomes, but I think we were surprised that the percentage of
patients who had a new disability after surgery was so high. It
wasn't just obese patients, I think it was elderly patients in
general,” Gauton said.
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Physicians may need to pay a little more attention to, and maybe
counsel, not just obese patients but elderly patients in general.
“They come in for surgery and an expectation of getting better. That
might not always be the case,” he said.
It is important to note that improvement was seen for most obese and
non-obese participants, said Dr. Michael Parks, an orthopedic
surgeon with the Hospital for Special Surgery in New York City who
wasn’t involved in the study.
“So, the point is, joint surgery is still helpful whether patients
are obese or not, but it shows that we need to do something for them
more than just replace their joint,” Parks said in a phone
interview.
“One of the things that we do here at HSS, and that I hope is
becoming more prevalent nationally, is we work collaboratively with
our medical colleagues to try to address obesity,” he said.
It’s also important for patients to become involved in their own
health care, Parks added.
“Whether you go to your primary care doctor, whether you go to a
nutritionist, whether you go next door to a center for weight loss
that's medical or whether you go to our center for weight loss
that's surgical, the point is, become involved in your health and do
something to lose weight to make yourself a better candidate because
that has implications on your surgical outcome, your risk, and this
study shows that it has a long-term outcome on your dependence and
your ability to be independent and your mobility," he said.
SOURCE: http://bit.ly/2BKQf1d British Journal of Anaesthesia, online
December 13, 2017.
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