Does Bariatric Surgery Normalize Risks After Total Knee Arthroplasty? Administrative Medicare Data

Patients with morbid obesity, defined as body mass index of greater than 40 kg/m(2), are being referred for weight loss and bariatric surgery before being accepted for a total knee arthroplasty (TKA). Previous studies have identified the risks associated with doing a TKA in an individual with an increased body mass index. We now present data identifying the same risks in individuals who have undergone bariatric surgery before submitting to TKA. QUESTIONS/PURPOSES: (1) Has the bariatric surgery improved the risk profile for the subsequent TKA? (2) Does the type of bariatric procedure matter? METHOD: A retrospective cohort study was conducted of patients who underwent bariatric surgery followed by TKA using Medicare hospital claims data. A study was undertaken using the Current Procedure Terminology codes and International Classification of Diseases-9 and International Classification of Diseases-10 for bariatric surgery. These identified entries were then cross-referenced to individuals who later underwent TKA, identified by CPT 27447, between 2004 and 2016. Twelve different types of complications which occurred in the 90-day period after the TKA were analyzed. RESULTS: Postbariatric bypass surgery patients showed a markedly elevated risk in most complications examined. In each category, the type of previous gastric surgery had notable differences in the post-TKA complication profile. In the implant failure category, the data demonstrated an even greater risk after a gastric bypass. When postbariatric patients were compared with morbidly obese individuals who had not undergone bariatric surgery, the hazard ratios (HRs) were markedly elevated for death (HR 1.47/bypass), implant failure (HR 1.58/sleeve), and pneumonia (HR 1.68/bypass). CONCLUSION: (1) Submitting to bariatric surgery is not sufficient to normalize risks. (2) The type of previous bariatric procedure is associated with the type of complications encountered. (3) We were unable to attribute TKA to bariatric failures. (4) Health systems and health care providers should be cautious in withholding care for patients with morbid obesity.