Bariatric surgery prior to elective shoulder arthroplasty: a Nationwide Inpatient Sample analysis

Abstract

BackgroundObesity has been linked to adverse outcomes after various orthopedic procedures, and bariatric surgery is an effective surgical treatment for morbid obesity. This study assesses whether prior bariatric surgery is associated with differences in hospital length of stay (LOS), discharge destination, and inpatient complication rate for elective shoulder arthroplasty. MethodsThe Nationwide Inpatient Sample database was queried from years 2003 to 2014 for all elective anatomic and reverse total shoulder arthroplasty cases. Two groups were defined: morbidly obese without prior bariatric surgery (MO cohort) and prior bariatric surgery without morbid obesity (BS cohort). Outcome measures were LOS (extended if greater than the 75th percentile), discharge destination (home or non-home), and any inpatient complication. Patients under age of 18 years and those with missing information were excluded. National estimates were calculated using weights provided by the Nationwide Inpatient Sample database. Chi-squared tests were performed for demographics and comorbidities. Binomial multivariate logistic regression was performed using significant demographics and comorbidities. ResultsA weighted-total of 19,877 patients were included in the study, of which 2783 were in the BS cohort and 17,094 were in the MO cohort. The BS group was younger (62.9 years vs. 66.0 years), had more females (73% vs. 69%), and was more likely to be anemic (15% vs. 10%). The MO group was more likely to have diabetes (40% vs. 22%), hypertension (83% vs. 65%), and peripheral vascular disease (3% vs. 1%). Multivariate analysis showed that the BS cohort had decreased odds of extended LOS (odds ratio [OR], 0.68), non-home discharge destination (OR, 0.67), and developing any inpatient complication (OR, 0.42). ConclusionIn the setting of anatomic and reverse total shoulder arthroplasties, patients with prior bariatric surgery and without morbid obesity had more favorable hospital LOS, discharge destination, and inpatient complication rate than morbidly obese patients with no prior bariatric surgery. Further studies are warranted to better elucidate the relationship between bariatric surgery and shoulder arthroplasty.