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J Clin Anesth. 2020 Feb;59:26-31. doi: 10.1016/j.jclinane.2019.06.012. Epub 2019 Jun 11.

The association of body mass index with same-day hospital admission, postoperative complications, and 30-day readmission following day-case eligible joint arthroscopy: A national registry analysis.

Author information

1
Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA. Electronic address: ragabriel@ucsd.edu.
2
School of Medicine, University of California, San Diego, La Jolla, CA, USA. Electronic address: bnburton@ucsd.edu.
3
Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA. Electronic address: jingrande@ucsd.edu.
4
Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: girish.joshi@utsouthwestern.edu.
5
Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA. Electronic address: rwaterman@ucsd.edu.
6
Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA. Electronic address: kspurr@ucsd.edu.
7
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. Electronic address: rurman@bwh.harvard.edu.

Abstract

STUDY OBJECTIVE:

We examined the association of body mass index (BMI) with hospital admission, same-day complications, and 30-day hospital readmission following day-case eligible joint arthroscopy.

DESIGN:

Retrospective cohort study.

SETTING:

Multi-institutional.

PATIENTS:

Adult patients undergoing arthroscopy of the knee, hip or shoulder in the outpatient setting.

INTERVENTION:

None.

MEASUREMENTS:

Using the American College of Surgeons National Surgical Quality Improvement Program dataset from 2012 to 2016, we examined seven BMI ranges: normal BMI (≥20 kg/m2 and <25 kg/m2), underweight (<20 kg/m2), overweight (≥25 kg/m2 and <30 kg/m2), Class 1 and 2 obese (≥30 kg/m2 and <40 kg/m2, reference variable), and severe obesity, which we divided into the following BMI ranges: ≥40 kg/m2 and <50 kg/m2, ≥50 kg/m2 and <60 kg/m2, and ≥60 kg/m2. The primary outcome was hospital admission. Secondary outcomes included same-day postoperative complications and 30-day hospital readmission. We performed multivariable logistic regression and reported odds ratios (OR) and their associated 95% confidence interval (CI) and considered a p-value of <0.05 as statistically significant.

MAIN RESULTS:

There were a total of 99,410 patients included in the final analysis, in which there was a 2.6% rate of hospital admission. When compared to class 3 obesity, only those with BMI ≥50 kg/m2(OR 1.55, 95% CI 1.18-2.01, p = 0.005) had increased odds of hospital admission. There were no differences in 30-day hospital readmission or same-day postoperative complications.

CONCLUSION:

We found that only patients with BMI ≥50 kg/m2 had increased odds for same-day hospital admission even when patient's comorbid conditions are optimized, suggesting that a BMI ≥50 kg/m2 may be used as a sole factor for patient selection in patients undergoing joint arthroscopy. For patients with BMI <50 kg/m2, we recommend that BMI alone should not be solely used to exclude patients from having joint arthroscopies performed in an outpatient setting, especially since this patient group makes up a significant proportion of joint arthroscopy.

KEYWORDS:

Ambulatory; BMI; Complications; Day surgery; Obesity; Outpatient surgery

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