The safety and efficacy of outpatient total hip arthroplasty in very obese patients
Bibliographic record
Abstract
Aims As the number of patients who undergo total joint replacement as an outpatient continues to increase, it is essential that the safety and efficacy of this form of treatment is maintained. The aim of this study was to examine the outcome in a series of very obese patients who underwent total hip arthroplasty (THA) as an outpatient. Methods A prospective database was used to identify 381 patients who underwent THA as an outpatient. Using case-control matching based on age, sex, and American Society of Anesthesiologists grade, 51 very obese patients with a BMI > 35 kg/m 2 were matched to 51 patients with a BMI < 35 kg/m 2 who underwent THA as an outpatient. In a subsequent analysis, 47 patients (41 THAs) from the same very obese cohort were matched to 47 very obese patients who underwent THA as an inpatient. For each group, readmission within 90 days, return to the emergency department (ED) within 90 days, adverse events, and reoperations were recorded. Results The mean BMI of the very obese outpatient group was 40 kg/m 2 (35 to 55); their mean age was 61 years (38 to 78). The mean BMI of the outpatients with a BMI < 35 kg/m 2 was 27 kg/m 2 (17 to 34); their mean age was 61 years (33 to 78). The mean BMI of the very obese inpatient group was 40 kg/m 2 (35 to 55); their mean age 62 years (34 to 77). Between the two outpatient groups, the rate of adverse events was significantly higher in the very obese group (15.69% compared with 1.96% (p = 0.015)). The reoperation rate was also significantly higher in the very obese group (five cases compared with none; p = 0.022). The rate of readmission and return to the ED within 90 days did not differ significantly between the groups (p = 0.299 and p = 0.092, respectively). There was no significant difference for all outcomes between the very obese patients who were treated as an outpatient and those who were treated as an inpatient. Conclusion The very obese group had significantly higher rates of adverse events and reoperations compared with those with a BMI < 35 kg/m 2 , but there was no difference when they were compared with a matched cohort of very obese patients who were treated as an inpatient. Caution must always be taken to identify the ideal candidates for outpatient surgery. However, BMI should not be used as a sole variable for deciding whether THA should be undertaken as an inpatient. Cite this article: Bone Joint J 2025;107-B(5 Supple A):3–8.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".