Total elbow arthroplasty complications and relation to body mass index: an American College of Surgeons National Surgery Quality Improvement Program database study

Abstract

BackgroundTotal elbow arthroplasty (TEA) is less common than total hip and knee arthroplasty, making examination of large cohorts difficult. Although the risk of complications with lower extremity arthroplasty has been associated with increasing body mass index (BMI), there has been limited data examining BMI and TEA complications. In this study, we use the American College of Surgeons National Surgery Quality Improvement Program database to analyze data on TEA complications and their association with BMI and other patient and surgical factors. We hypothesized that increased BMI would be associated with increased perioperative complications after TEA. MethodsThe American College of Surgeons National Surgery Quality Improvement Program database was queried between 2005 and 2018 for all patients undergoing TEA by the Current Procedural Terminology code. De-identified data were reviewed for 615 patients to compare patient demographics, BMI, preoperative diagnosis, medical comorbidities, surgical characteristics, and 30-day complications. Statistical analysis was performed to evaluate our hypothesis. Multivariable logistic regression analysis of patient and surgical factors was performed to determine the association with postoperative complications. ResultsThe complications of TEA were not associated with BMI, American Society of Anesthesiologists (ASA) class, diagnosis, or age. The overall 30-day postoperative complication rate was 10.5%. There was a significantly lower rate of complications with outpatient TEA (odds ratio [OR] 0.20; P < .01). Higher risk of complications was associated with increasing operative time (OR 1.01; P < .01) and patients who were not functionally independently (OR 2.37; P = .047). ConclusionsThis analysis did not show an association between BMI and complications after TEA; however, longer operative time, lack of functional independence, and inpatient hospital stay were found to be associated with an increased risk of 30-day postoperative complications after TEA. Level of evidenceLevel IV; Database Retrospective Case Series Treatment Study