Two new studies at the Hospital for Special Surgery (HSS) indicate that bariatric surgery prior to joint replacement serves as a cost-effective option to improve outcomes following hip or knee replacement.
One study investigates the costs and benefits of weight-loss surgery prior to knee replacement, and the other analyzes the costs and benefits prior to hip replacement, according to an HSS news release.
Emily Dodwell, MD, orthopedic surgeon at HSS and lead investigator, states in the release that up to 50% of hip replacements are performed in obese patients at some institutions.
“Obesity is associated with longer hospital stays, higher overall costs, and higher failure rates, necessitating costly revision surgery,” Dodwell says.
While bariatric surgery is a cost-effective intervention for morbid obesity, adds Alexander McLawhorn, MD, chief orthopedic surgery resident at HSS and study author, “the cost-effectiveness of bariatric surgery to achieve weight loss prior to joint replacement and thus decrease the associated complications and costs in morbidly obese patients was unknown.”
The release reports that investigators used a sophisticated computer software program to compare the cost-utility of two treatment protocols for patients who were considered morbidly obese and had advanced knee or hip osteoarthritis (OA). One group underwent joint replacement immediately, without losing weight. The second group underwent bariatric surgery, followed by hip or knee replacement 2 years later. The release says patients typically lose weight during this time period.
For the study, the researchers chose a decision analysis design “because we could use a mathematical model to simulate the outcomes and costs of each treatment path based on results and costs that have already been published in the literature,” Dodwell notes.
The release states that study patients had a BMI of at least 40, or a BMI of 35 or higher and at least one other serious obesity-related health problem. For study purposes, the researchers assumed that at least one-third of patients having bariatric surgery lost their excess weight prior to undergoing joint replacement.
Dodwell points out that the findings suggest that surgical weight loss prior to joint replacement is likely a cost-effective option from a public payor standpoint in order to improve outcomes in obese patients who are candidates for joint replacement.
Additionally, McLawhorn points out that it may be impractical to hold off joint replacement for some patients experiencing sever knee or hip pain.
“Ideally, a team approach would be used to treat morbidly obese patients with hip and knee arthritis in which various health care professionals are in place to help a patient lose weight, improve his or her health, and optimize nutrition before joint replacement to maximize its benefits,” he explains.
Source: Hospital for Special Surgery