The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy

A national registry analysis

Rodney A. Gabriel, Brittany N. Burton, Jerry Ingrande, Girish P Joshi, Ruth S. Waterman, Kristin R. Spurr, Richard D. Urman

Research output: Contribution to journalArticle

Abstract

Study objective: We examined the association of body mass index (BMI) with hospital admission, same-day complications, and 30-day hospital readmission following day-case eligible joint arthroscopy. Design: Retrospective cohort study. Setting: Multi-institutional. Patients: Adult patients undergoing arthroscopy of the knee, hip or shoulder in the outpatient setting. Intervention: None. Measurements: Using the American College of Surgeons National Surgical Quality Improvement Program dataset from 2012 to 2016, we examined seven BMI ranges: normal BMI (≥20 kg/m2 and <25 kg/m2), underweight (<20 kg/m2), overweight (≥25 kg/m2 and <30 kg/m2), Class 1 and 2 obese (≥30 kg/m2 and <40 kg/m2, reference variable), and severe obesity, which we divided into the following BMI ranges: ≥40 kg/m2 and <50 kg/m2, ≥50 kg/m2 and <60 kg/m2, and ≥60 kg/m2. The primary outcome was hospital admission. Secondary outcomes included same-day postoperative complications and 30-day hospital readmission. We performed multivariable logistic regression and reported odds ratios (OR) and their associated 95% confidence interval (CI) and considered a p-value of <0.05 as statistically significant. Main results: There were a total of 99,410 patients included in the final analysis, in which there was a 2.6% rate of hospital admission. When compared to class 3 obesity, only those with BMI ≥50 kg/m2(OR 1.55, 95% CI 1.18–2.01, p = 0.005) had increased odds of hospital admission. There were no differences in 30-day hospital readmission or same-day postoperative complications. Conclusion: We found that only patients with BMI ≥50 kg/m2 had increased odds for same-day hospital admission even when patient's comorbid conditions are optimized, suggesting that a BMI ≥50 kg/m2 may be used as a sole factor for patient selection in patients undergoing joint arthroscopy. For patients with BMI <50 kg/m2, we recommend that BMI alone should not be solely used to exclude patients from having joint arthroscopies performed in an outpatient setting, especially since this patient group makes up a significant proportion of joint arthroscopy.

Original languageEnglish (US)
Pages (from-to)26-31
Number of pages6
JournalJournal of Clinical Anesthesia
Volume59
DOIs
StatePublished - Feb 1 2020

Fingerprint

Arthroscopy
Registries
Body Mass Index
Joints
Patient Readmission
Outpatients
Odds Ratio
Confidence Intervals
Morbid Obesity
Thinness
Quality Improvement
Patient Selection
Hip
Knee
Reference Values
Cohort Studies
Retrospective Studies
Obesity
Logistic Models

Keywords

  • Ambulatory
  • BMI
  • Complications
  • Day surgery
  • Obesity
  • Outpatient surgery

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy : A national registry analysis. / Gabriel, Rodney A.; Burton, Brittany N.; Ingrande, Jerry; Joshi, Girish P; Waterman, Ruth S.; Spurr, Kristin R.; Urman, Richard D.

In: Journal of Clinical Anesthesia, Vol. 59, 01.02.2020, p. 26-31.

Research output: Contribution to journalArticle

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abstract = "Study objective: We examined the association of body mass index (BMI) with hospital admission, same-day complications, and 30-day hospital readmission following day-case eligible joint arthroscopy. Design: Retrospective cohort study. Setting: Multi-institutional. Patients: Adult patients undergoing arthroscopy of the knee, hip or shoulder in the outpatient setting. Intervention: None. Measurements: Using the American College of Surgeons National Surgical Quality Improvement Program dataset from 2012 to 2016, we examined seven BMI ranges: normal BMI (≥20 kg/m2 and <25 kg/m2), underweight (<20 kg/m2), overweight (≥25 kg/m2 and <30 kg/m2), Class 1 and 2 obese (≥30 kg/m2 and <40 kg/m2, reference variable), and severe obesity, which we divided into the following BMI ranges: ≥40 kg/m2 and <50 kg/m2, ≥50 kg/m2 and <60 kg/m2, and ≥60 kg/m2. The primary outcome was hospital admission. Secondary outcomes included same-day postoperative complications and 30-day hospital readmission. We performed multivariable logistic regression and reported odds ratios (OR) and their associated 95{\%} confidence interval (CI) and considered a p-value of <0.05 as statistically significant. Main results: There were a total of 99,410 patients included in the final analysis, in which there was a 2.6{\%} rate of hospital admission. When compared to class 3 obesity, only those with BMI ≥50 kg/m2(OR 1.55, 95{\%} CI 1.18–2.01, p = 0.005) had increased odds of hospital admission. There were no differences in 30-day hospital readmission or same-day postoperative complications. Conclusion: We found that only patients with BMI ≥50 kg/m2 had increased odds for same-day hospital admission even when patient's comorbid conditions are optimized, suggesting that a BMI ≥50 kg/m2 may be used as a sole factor for patient selection in patients undergoing joint arthroscopy. For patients with BMI <50 kg/m2, we recommend that BMI alone should not be solely used to exclude patients from having joint arthroscopies performed in an outpatient setting, especially since this patient group makes up a significant proportion of joint arthroscopy.",
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AU - Gabriel, Rodney A.

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AU - Ingrande, Jerry

AU - Joshi, Girish P

AU - Waterman, Ruth S.

AU - Spurr, Kristin R.

AU - Urman, Richard D.

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KW - Complications

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