Risk of complications in patients who are obese following upper limb arthroplasty: A systematic review and meta-analysis

Purpose: A systematic review was performed to investigate the impact of obesity on complications following total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA) and total elbow arthroplasty (TEA). Methods: Electronic databases and grey literature were searched for studies that evaluated the influence of obesity (Body Mass Index[BMI] >= 30 kg m(2)) on upper limb arthroplasty outcomes. Fifteen studies were identified, however only twelve reported predetermined outcomes. Unadjusted data was pooled in statistical meta-analysis where appropriate. Effect sizes were expressed as odds ratios (OR) for categorical data and weighted mean differences for continuous data. Results: Odds of infection increased with increasing BMI, from 2.37 (95%CI [1.653.41]) times in patients who were obese, to greater than five times (OR = 5.04; 95%CI [4.705.39]) in patients who were morbidly obese. Furthermore, patients who were obese or morbidly obese had 3.92 (95%CI [3.594.28]) to 5.46 (95%CI [4.916.07]) times greater odds of venous thromboembolism (VTE) compared to their non-obese counterparts, respectively. Conversely, obesity had no influence on the odds of urinary tract infection (OR = 0.88; 95%CI [0.481.61], or mortality (OR = 1.79; 95%CI [0.794.03]). TSA/RTSA patients who were obese experienced operations 10.00 minutes longer (95%CI [6.3113.69]) than patients with a BMI in the normal range, which increased to 12.48 min utes (95%CI [8.4016.55]) in patients with a BMI >= 35.0. Evidence examining the influence of obesity on blood transfusion was inconclusive, while minimal evidence was available on pneumonia. Conclusion: Surgeons should consider advising patients who are obese of the greater risk of VTE and infection when considering elective upper limb arthroplasty. However, noteworthy limitations surrounded the lack of information regarding prophylaxis regimes and BMI measurement tools used in included studies. (C) 2020 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.