The Impact of Body Mass Index on Complications After Shoulder Arthroscopy: Should Surgery Eligibility Be Determined by Body Mass Index Cutoffs?

Abstract

The goal of this study is to analyze postoperative complications after shoulder arthroscopy stratified by body mass index (BMI) and to quantify the trade-off in postsurgical complications and access to care that occurs with BMI eligibility cutoffs. Patients who underwent shoulder arthroscopy in the National Surgical Quality Improvement Program database from 2015 to 2016 were identified. Patients were categorized on the basis of their BMI. χ2 tests were used to identify differences in complication rates between different BMI categories. Logistic regression was used to calculate the odds ratio of having a major complication by BMI category. The positive predictive value (PPV) was calculated at different BMI cutoffs. There were 26,509 shoulder arthroscopy cases identified in the National Surgical Quality Improvement Program database with 383 major complications, for an overall rate of 1.4%. Patients with a BMI >40 had a higher overall complication rate (2.3% vs 1.4%, P= .001), as well as higher rates of readmission (P=.012), pneumonia (P= .030), progressive renal insufficiency (P= .006), and cardiac arrest (P= .008). BMI >40 was associated with an increased risk of major complications (odds ratio, 1.84; confidence interval, 1.29-2.61). A BMI cutoff of 40 would avoid 12% of major complications while excluding 8% of complication-free surgeries. At a BMI cutoff of 40, the PPV was 2.3% where 43 surgeries would be denied for every complication avoided. Patients with a BMI>40 have a statistically significant but only slightly increased risk of 30-day complications after shoulder arthroscopy. Instituting a BMI eligibility cutoff at 40 has a low PPV and would prevent 43 complication-free surgeries from proceeding for every complication prevented. Patients should be counseled individually about their risk factors, but denial of shoulder arthroscopy on the basis of BMI alone may not be an appropriate strategy for risk reduction. Level III, comparative prognostic trial.