Underweight patients are in the highest risk body mass index
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Those with elevated BMI have been the subject of current literature examining the association of body mass index (BMI) with surgical complications. Mixed conclusions, possible due to inadequate capacity, poor control of confounding variables and contradictory definitions of BMI categories, have been recorded in these studies (eg, underweight, overweight, and varying classifications of obese). Few studies have considered risks in low-BMI patients. The purpose of the current research was to evaluate the spectrum of BMI categories with 30-day perioperative adverse effects following primary complete shoulder arthroplasty (TSA) in order to better determine where patients are at risk along the BMI spectrum.

Patients undergoing elective TSA were abstracted from the National Surgical Quality Improvement Program (NSQIP) databases. Patients were then aggregated into BMI categories, and 30-day adverse events were normalized to average risk of normal-weight subjects (BMI 18.5 to 24.9 kg/m2). Risk-adjusted multivariate regressions were performed, controlling for demographic variables and overall health.

In total, 15717 patients met the inclusion criteria.
--Underweight TSA patients (BMI less than 18.5 kg/m2) had the greatest odds for multiple perioperative adverse events compared with any other BMI category.

--By multivariate analysis, underweight patients were more likely to experience any adverse event (odds ratio [OR] = 2.22), serious adverse events (OR = 3.18) or have postoperative infections (OR = 2.77) within 30 days when compared with normal-weight patients.

--No significant difference was observed in these complications for elevated BMI categories when compared with normal-weight patients.

In particular, in comparison to any overweight/obese group, including super morbidly obese, only underweight TSA patients were found to have higher rates of 30-day perioperative adverse effects than normal BMI patients. Thus, TSA underweight patients were described as an at-risk subpopulation of patients with TSA. This fragile cohort should be given extra consideration by physicians and healthcare systems since they already already do for those at the other end of the BMI spectrum.

Source: https://journals.lww.com/jaaos/Abstract/2021/02010/Underweight_Patients_Are_the_Greatest_Risk_Body.11.aspx