A Reduction in Body Mass Index From ≥ 40 to < 40 Lowers Emergency Department Visits, but May Increase All-Cause Readmissions After Primary Total Hip Arthroplasty: Conflicting 90-Day Outcomes at a Single Institution

Background: The American Association of Hip and Knee Surgeons tasked a 2013 workgroup to provide obesity-related recommendations in total joint arthroplasty. Morbidly obese patients (body mass index (BMI) >= 40) seeking hip arthroplasty were determined to be at increased perioperative risk, and surgeons were recommended to encourage these patients to reduce their BMI <40 presurgery. We report the effect of instituting a 2014 BMI <40 threshold on our primary total hip arthroplasties (THAs). Methods: We queried our institutional database to select all primary THAs from January 2010 to May 2020. There were 1,383 THAs that were pre-2014 and 3,273 THAs that were post-2014. The 90-day emergency department (ED) visits, readmissions, and returns to operating room (OR) were identified. Patients were propensity score weight-matched according to comorbidities, age, initial surgical consultation (consult) BMI, and sex. We conducted 3 comparisons: A) pre-2014 patients who had a consult and surgical BMI >= 40 against post-2014 patients who had a consult BMI >= 40 and surgical BMI <40; B) pre-2014 patients against post-2014 patients who had a consult and surgical BMI <40; and C) post-2014 patients who had a consult BMI >= 40 and surgical BMI <40 against post-2014 patients who had a consult BMI >= 40 and surgical BMI >= 40. Results: Post-2014 patients who had a consult BMI >= 40 and surgical BMI <40 had less ED visits (7.6 versus 14.1%, P =.0007), but similar readmissions (11.9 versus 6.3%, P =.22) and returns to OR (5.4 versus 1.6%, P =.09) compared to pre-2014 patients who had a consult BMI and surgical BMI >= 40. Post-2014 BMI <40 had less readmissions (5.9 versus 9.3%, P <.0001), and similar all-cause returns to OR and ED visits than patients pre-2014. Post-2014 patientswho had a consult and surgical BMI >= 40 had lower readmissions (12.5 versus 12.8%, P =.05), and similar ED visits and returns to OR than consult BMI >= 40 and surgical BMI <40. Conclusion: Patient optimization prior to total joint arthroplasty is critical. However, the BMI optimization that mitigates risk in primary total knee arthroplasty may not apply to primary THA. We observed a paradoxical increased readmission rate for patients who reduced their BMI before THA. Level of Evidence: III. (c) 2023 Elsevier Inc. All rights reserved.