Early outcomes and complications of obese patients undergoing shoulder arthroplasty: A meta-analysis

Abstract

ObjectiveThe prevalence of obesity and shoulder arthroplasty have both been increasing in the United States. Although lower extremity arthroplasty literature suggests higher complication rates in these patients, there is a paucity of studies evaluating the outcome of shoulder arthroplasty in obese patients. Our purpose was to perform a meta-analysis to determine clinical outcomes and complications of these patients. MethodsFollowing the PRISMA guidelines, the MEDLINE (PubMed), Embase, and Ovid libraries were used to perform a comprehensive literature review to compare complications and outcomes following shoulder arthroplasty between obese and non-obese patients. Our initial search returned 143 publications. Our inclusion criteria included full-text reports, minimum follow-up of 1 year, minimum of 10 patients, no cadaveric or biomechanical studies, only studies published in English, studies involving obese patients undergoing either anatomic or reverse shoulder arthroplasty. A total of 13 studies met the inclusion criteria. These studies were then evaluating using a methodological index for non-randomized studies (MINORS) score. Ultimately, 6 studies met our criteria and were included in the final analysis. ResultsA total of 978 patients were identified from the 6 studies. Patients with a BMI <30 kg/m2 had a complication rate of 9.7% and American Shoulder and Elbow Surgeons score (ASES) increased from 37.4 to 76.7. Patients with a BMI >30 kg/m2 had a complications rate of 6.5% and ASES increased from 34.4 to 76.2. Patients with a BMI >40 kg/m2 ASES increased from 29.5 to 68.6. The postoperative ASES score of 68.6 for patients with a BMI >40 kg/m2 was significantly lower than the ASES score of 76.8 in patients with a BMI <40 kg/m2 (p = 0.007). There were an insufficient number of patients and an insufficient number of complications to perform any meaningful statistical test on complication rates in patients with a BMI >40 kg/m2. ConclusionNo significant difference was observed in number of complications and follow-up ASES scores following shoulder arthroplasty between obese and non-obese patients. Morbidly obese patients (BMI > 40 kg/m2) have a significantly lower ASES follow-up score than non-morbidly obese patients; however, this difference may not be clinically significant. Future studies are needed to investigate outcomes and complications associated with morbidly obese patients undergoing shoulder arthroplasty.