Overweight patients at greater risk of post-surgery complications

Being overweight increases the risk of complications after joint replacement surgery, according to new data.

Post-surgery complications are more common among overweight patients, according to new safety and quality data. Picture: Pete Hausler for The Wall Street Journal

Being overweight or obese makes you more likely to need a joint replacement but also increases the risk of complications after surgery, according to new safety and quality data.

An analysis of data on the Australian Orthopaedic Association’s Joint Replacement Registry, to be released today, reveals the influence of a patient’s overall health and weight on surgical outcomes.

More hip, knee and shoulder replacements are being performed in Australia, partly due to rising obesity rates and the ageing population, however the revision rate has remained steady or improved in recent years.

“Unsurprisingly, those in the best health and close to normal BMI are significantly less

likely to require revision surgery,” AOA president Dr Lawrence Malisano said yesterday.

“However, we are just now understanding the role that BMI and (health score) has on joint replacement patients.”

“Being overweight increases a person’s likelihood of needing a joint replacement but it

also increases their risk of complications. One of the important issues for the registry

to resolve now that it has identified these differences is how best to improve the

results in patients with poor health and who are within the obese categories of BMI.”

Complications after surgery are more common for those outside a healthy BMI range.

The analysis also looked at outcomes for people over the age of 80 undergoing hip and knee joint replacement. Although the risk of post-operative mortality was slightly higher given the age of the patients — for those undergoing hip replacement, there may be benefit in being heavier — the AOA deemed joint replacement a relatively safe option.

“The elderly can benefit for many years following joint replacement surgery with 80 per cent

of those in the 80-89 age group and 60 per cent of the 90-plus age group surviving at least five years after surgery,” Dr Malisano said.

“At 10 years, over 40 per cent of the 80-89 age group and almost 15 per cent of

the 90-plus age group are still alive.”

The AOA has also identified 11 new prosthesis as having higher than anticipated rates of revision and notified the Therapeutic Goods Administration.

Private health insurers’ concerns over the cost of in-hospital rehabilitation after joint replacement surgery, and evidence it may be no better than home-based care, prompted Health Minister Greg Hunt to ask an expert committee to consider reform options.

At a meeting in May, the committee acknowledged that while alternatives to in-hospital rehabilitation might be more efficient, large-scale changes would be needed to deliver savings, and perhaps insurers could also fund pre-operative services.

“Members considered an option to support the delivery of ‘pre-habilitation’ funded by private health insurance, particularly relevant for orthopaedic services,” minutes of the meeting state.

The option would package or bundle funding for pre-operative services, joint replacement surgery, and rehabilitation.