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Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications

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العنوان: Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications
المؤلفون: Katie L. Elcock, Thomas H. Carter, Liam Z. Yapp, Deborah J. MacDonald, Colin R. Howie, Andrew Stoddart, Guy Berg, Nick D. Clement, Chloe E. H. Scott
المصدر: Elcock, K L, Carter, T H, Yapp, L Z, MacDonald, D J, Howie, C R, Stoddart, A, Berg, G, Clement, N D & Scott, C E H 2022, ' Total knee arthroplasty in patients with severe obesity provides value for money despite increased complications ', The Bone & Joint Journal, vol. 104-B, no. 4, pp. 452-463 . https://doi.org/10.1302/0301-620X.104B4.BJJ-2021-0353.R3
سنة النشر: 2022
مصطلحات موضوعية: Osteoarthritis, Knee, Obesity, Morbid, Obesity, Morbid/complications, Humans, Orthopedics and Sports Medicine, Surgery, Female, Obesity, Quality-Adjusted Life Years, Obesity/complications, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee/surgery, Arthroplasty, Replacement, Knee/methods, Aged
الوصف: Aims Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m2 to examine whether this is supported. Methods This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m2) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m2 in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient’s lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. Results All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m2: 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m2. In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m2 and £5,275 in patients with a BMI ≥ 40 kg/m2. Conclusion Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m2, suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452–463.
وصف الملف: application/pdf
تدمد: 2049-4408
DOI: 10.1302/0301-620X.104B4.BJJ-2021-0353.R3
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dd5757a13acb79875b51b8a2cca8acc0
https://pubmed.ncbi.nlm.nih.gov/35360945
Rights: OPEN
رقم الانضمام: edsair.doi.dedup.....dd5757a13acb79875b51b8a2cca8acc0
قاعدة البيانات: OpenAIRE
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