2009 Annual Meeting Poster Presentations
Morbidly Obese TKA Patients Require Lengthier Operative Procedure and Hospital Stay
Poster Presentation Number: P155 Location: Venetian/Sands EXPO Hall DAdult Reconstruction Knee
Cale Jacobs, PhD Lexington KYChristian P Christensen, MD Lexington KY
Morbidly obese patients had significantly longer operative times and hospitals stays, and a significantly greater proportion required care at a rehabilitation or skilled nursing facility.
Despite previous reports that morbidly obese patients are at greater risk of complications and poor outcomes after TKA, surgeon and hospital reimbursement for these patients does not appear to differ from non-obese patients. We used 22 modifiers for 93 morbidly obese patients for whom Medicare was the primary insurer, and were only reimbursed for this modifier 3 times. The purpose of this study was to determine if the duration of the operative procedure, length of hospital stay, and discharge location differed between groups of morbidly obese and non-obese TKA patients in an effort to demonstrate increased demands placed on the healthcare system.
Since August, 2003, a single surgeon performed primary TKA in 653 knees (585 patients) for which complete surgical and hospital data was available. Of the 653 knees, 202 were in patients with BMI less than 30 and 146 were in patients with BMI of 40 or more. We compared patient age, tourniquet time during the surgery, and the length of hospital stay between these 2 groups. We also compared the proportion of patients in each group that were discharged to a rehabilitation or skilled nursing facility.
Morbidly obese patients were significantly younger (p<.001), and had significantly greater tourniquet times (p=.01) and length of hospital stay (p=.04) compared to non-obese TKA patients. In addition, a significantly greater proportion of morbidly obese patients were discharged to a rehabilitation or skilled nursing facility (p=.01).
Despite being significantly younger, morbidly obese patients had significantly longer operative times and hospitals stays, and a significantly greater proportion of the morbidly obese patients required care at a rehabilitation or skilled nursing facility. Morbidly obese patients place greater demand on the surgeon, hospital, and health care system and generate correspondingly greater health care costs.
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