1
|
Hameed D, Bains SS, Dubin JA, Shul C, Chen Z, Stein A, Nace J, Mont MA. Timing Matters: Optimizing the Timeframe for Preoperative Weight Loss to Mitigate Postoperative Infection Risks in Total Knee Arthroplasty. J Arthroplasty 2024; 39:1419-1423.e1. [PMID: 38135167 DOI: 10.1016/j.arth.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We explore the incidence of periprosthetic infections post-total knee arthroplasty (TKA) in morbidly obese patients who achieved weight loss. Current American Academy of Orthopaedic Surgeons guidelines suggest a preoperative body mass index (BMI) below 40 for TKA. This study assesses infection risks in patients initially who had a BMI of 40-50 who reduced their BMI to under 35 at varying intervals prior to surgery. METHODS We reviewed a national, all-payer database, PearlDiver, for patients undergoing primary TKA. Patients were stratified based on initial BMI of 40 to 50 and reduction of BMI to less than 35 at 3 months (n = 1,932), 3 to 6 months (n = 794), 6 to 9 months (n = 2,233), and 9 to 12 months (n = 1,194) prior to TKA, as well as patients who had a BMI between 40 to 50 (n = 41,632) on the day of surgery. The nonobese group comprised of patients who had a BMI between 20 and 30 (n = 33,294). Multivariate analyses were performed at one-year follow-up. RESULTS We found an increased risk of PJI for patients who had achieved BMI reduction less than nine months prior to TKA, compared to the BMI 20 to 30 cohort at the one-year follow-up (P < .001). Patients who achieved BMI reduction nine to twelve months prior to TKA showed no significant difference in PJI risk compared to the matching nonobese cohort at one-year follow-up (P = .400). CONCLUSIONS In conclusion, our results suggest that weight loss should be achieved at least nine months before TKA to decrease infection risks. These findings have significant implications for surgical considerations in obese patients undergoing TKA.
Collapse
Affiliation(s)
- Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Craig Shul
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Alexandra Stein
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| |
Collapse
|
2
|
de Ree RH, de Jong LD, Hazebroek EJ, Somford MP. Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review. J Clin Orthop Trauma 2024; 52:102423. [PMID: 38766387 PMCID: PMC11096744 DOI: 10.1016/j.jcot.2024.102423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/18/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024] Open
Abstract
Background Obesity is a risk factor for the development of osteoarthritis and contributes to the increasing demand for total joint arthroplasty (TJA). Because a lower preoperative weight decreases the risk of complications after TJA, and because bariatric surgery (BS) can reduce weight and comorbidity burden, orthopedic surgeons often recommend BS prior to TJA in patients with obesity. However, the optimal timing of TJA after BS in terms of complications, revisions and dislocations is unknown. Methods PubMed, Embase and Cochrane CENTRAL databases were systematically searched for any type of study reporting rates of complications, revisions and dislocations in patients who had TJA after BS. The included studies' quality was assessed using the Newcastle-Ottawa Scale. Results Out of the 16 studies eligible for review, eight registry-based retrospective studies of high to moderate quality compared different time periods between BS and TJA and overall their results suggest little differences in complication rates. The remaining eight retrospective studies evaluated only one time period and had moderate to poor quality. Overall, there were no clear differences in outcomes after TJA for the different time frames between BS and TJA. Conclusion The results of this systematic review suggest that there is limited and insufficient high-quality evidence to determine the optimal timing of TJA after BS in terms of the rates of complications, revisions and dislocations. Given this lack of evidence, timing of TJA after BS will have to be decided by weighing the individual patients' risk factors against the expected benefits of TJA.
Collapse
Affiliation(s)
- Roy H.G.M. de Ree
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Lex D. de Jong
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Eric J. Hazebroek
- Department of Bariatric Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| | - Matthijs P. Somford
- Department of Orthopaedics, Rijnstate Hospital, Wagnerlaan 55, 6815, AD, Arnhem, the Netherlands
| |
Collapse
|
3
|
De Mauro D, Balato G, Festa E, Di Cristo A, Marasco L, Loffredo G, Di Lauro P, Di Gennaro D, Maccauro G, Rosa D. Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis. BMC Musculoskelet Disord 2024; 25:248. [PMID: 38561717 PMCID: PMC10983737 DOI: 10.1186/s12891-024-07288-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS. METHODS Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach. RESULTS The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975). CONCLUSIONS The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.
Collapse
Affiliation(s)
- D De Mauro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy.
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy.
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - G Balato
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - E Festa
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy.
| | - A Di Cristo
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - L Marasco
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - G Loffredo
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - P Di Lauro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - D Di Gennaro
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| | - G Maccauro
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Rosa
- Department of Public Health, Orthopedic Unit, "Federico II" University, Via Sergio Pansini, 5, Naples, 80130, Italy
| |
Collapse
|
4
|
Chan PYW, Mika AP, Martin JR, Wilson JM. Glucagon-like Peptide-1 Agonists: What the Orthopaedic Surgeon Needs to Know. JBJS Rev 2024; 12:01874474-202401000-00003. [PMID: 38181103 DOI: 10.2106/jbjs.rvw.23.00167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
» Orthopaedic surgeons are increasingly likely to encounter patients with obesity and/or type 2 diabetes taking glucagon-like peptide-1 (GLP-1) agonists for weight loss.» GLP-1 agonists are an effective treatment for weight loss with semaglutide and tirzepatide being the most effective agents. Randomized controlled trials using these agents have reported weight loss up to 21 kg (46 lb).» The use of GLP-1 agonists preoperatively can improve glycemic control, which can potentially reduce the risk of postoperative complications. However, multiple cases of intraoperative aspiration/regurgitation have been reported, potentially related to the effect of GLP-1 agonists on gastric emptying.» While efficacious, GLP-1 agonists may not produce sufficient weight loss to achieve body mass index cutoffs for total joint arthroplasty depending on individual patient factors, including starting bodyweight. Multifactorial approaches to weight loss with focus on lifestyle modification in addition to GLP-1 agonists should be considered in such patients.» Although GLP-1 agonists are efficacious agents for weight loss, they may not be accessible or affordable for all patients. Each patient's unique circumstances should be considered when creating an ideal weight loss plan during optimization efforts.
Collapse
Affiliation(s)
- Peter Y W Chan
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | |
Collapse
|
5
|
Zink TM, Kent SE, Choudhary AN, Kavolus JJ. Nutrition in Surgery: An Orthopaedic Perspective. J Bone Joint Surg Am 2023; 105:1897-1906. [PMID: 37856576 DOI: 10.2106/jbjs.23.00259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
➤ Malnutrition is common among subsets of patients undergoing orthopaedic surgery and is associated with an increased risk of postoperative complications.➤ Serum proteins, in particular, albumin, may be used in the evaluation of nutritional status.➤ Anthropometric measurements and surveys also play a role in the evaluation of nutritional status.➤ Increased energy and nutrient requirements due to surgical procedures necessitate increased caloric and protein intake in the perioperative period, which may be achieved through diet or supplementation.➤ Evidence supports the use of protein-calorie, amino acid, and immunonutrition supplements. Vitamin D supplementation is an area of further consideration.➤ Diet restriction, activity alterations, pharmacotherapy, and bariatric surgery are all safe, effective approaches to weight loss, although the optimal timing and magnitude of preoperative weight loss require further investigation.
Collapse
Affiliation(s)
- Thomas M Zink
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - Suzanne E Kent
- Tufts Medical Center, Boston, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | | | - Joseph J Kavolus
- Tufts University School of Medicine, Boston, Massachusetts
- Newton-Wellesley Orthopedic Associates, Newton, Massachusetts
| |
Collapse
|
6
|
Illescas A, Zhong H, Cozowicz C, Poeran J, Memtsoudis SG, Liu J. Anesthesia practice among joint arthroplasty patients with a previous lumbar spine surgery. J Clin Anesth 2023; 90:111222. [PMID: 37499315 DOI: 10.1016/j.jclinane.2023.111222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/22/2023] [Accepted: 07/19/2023] [Indexed: 07/29/2023]
Abstract
STUDY OBJECTIVE To analyze the use of neuraxial techniques in total hip or knee arthroplasty patients who previously underwent lumbar spine surgeries. DESIGN Retrospective analysis of a national database. SETTING U.S. hospitals. PATIENTS Patients undergoing a total hip or knee arthroplasty, stratified by those with a previous lumbar fusion or decompression procedure. MEASUREMENTS Our primary outcome was the use of neuraxial anesthesia; secondary outcomes included combined complications, cardio-pulmonary complications, and prolonged length of stay. Patients with and without a history of a lumbar procedure were compared using mixed-effects regression. MAIN RESULTS Among 758,857 THAs 8961 had a history of lumbar fusion and 8599 of decompression. Among 1,387,335 TKAs 15,827 had a history of lumbar fusion and 13,652 of decompression. History of a lumbar fusion was associated with lower odds of neuraxial anesthesia use in THA (OR: 0.74 CI: 0.70-0.79, p ≤0.0001) and TKA (OR: 0.80 CI: 0.77-0.84, p ≤0.0001). CONCLUSIONS Previous lumbar fusion -but not decompression- surgery is associated with lower neuraxial anesthesia in THA/TKA patients, despite its use being universally associated with decreased length of stay. More research is needed to address the importance of neuraxial techniques in patients with prior spine surgery.
Collapse
Affiliation(s)
- Alex Illescas
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Haoyan Zhong
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA
| | - Crispiana Cozowicz
- Paracelsus Medical University, Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Salzburg, Austria
| | - Jashvant Poeran
- Institute for Healthcare Delivery Science, Department of Population Health Science & Policy/Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stavros G Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA; Department of Health Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Jiabin Liu
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
7
|
Ighani Arani P, Wretenberg P, Stenberg E, Ottosson J, W-Dahl A. Total knee arthroplasty and bariatric surgery: change in BMI and risk of revision depending on sequence of surgery. BMC Surg 2023; 23:53. [PMID: 36899340 PMCID: PMC10007771 DOI: 10.1186/s12893-023-01951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Patients with obesity have a higher risk of complications after total knee arthroplasty (TKA). We investigated the change in weight 1 and 2 years post-Bariatric Surgery (BS) in patients that had undergone both TKA and BS as well as the risk of revision after TKA based on if BS was performed before or after the TKA. METHODS Patients who had undergone BS within 2 years before or after TKA were identified from the Scandinavian Obesity Surgery Register (SOReg) and the Swedish Knee Arthroplasty Register (SKAR) between 2007 and 2019 and 2009 and 2020, respectively. The cohort was divided into two groups; patients who underwent TKA before BS (TKA-BS) and patients who underwent BS before TKA (BS-TKA). Multilinear regression analysis and a Cox proportional hazards model were used to analyze weight change after BS and the risk of revision after TKA. RESULTS Of the 584 patients included in the study, 119 patients underwent TKA before BS and 465 underwent BS before TKA. No association was detected between the sequence of surgery and total weight loss 1 and 2 years post-BS, - 0.1 (95% confidence interval (CI), - 1.7 to 1.5) and - 1.2 (95% CI, - 5.2 to 2.9), or the risk of revision after TKA [hazard ratio 1.54 (95% CI 0.5-4.5)]. CONCLUSION The sequence of surgery in patients undergoing both BS and TKA does not appear to be associated with weight loss after BS or the risk of revision after TKA.
Collapse
Affiliation(s)
- Perna Ighani Arani
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden. .,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.
| | - Per Wretenberg
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden
| | - Erik Stenberg
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Scandinavian Obesity Surgery Registry, Örebro, Sweden
| | - Johan Ottosson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 702 81, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden.,Scandinavian Obesity Surgery Registry, Örebro, Sweden
| | - Annette W-Dahl
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, OrthopedicsLund, Sweden.,The Swedish Arthroplasty Register, Göteborg, Sweden
| |
Collapse
|
8
|
A commentary on "Does bariatric surgery really benefit patients before total knee arthroplasty? A systematic review and meta-analysis" (Int. J. Surg. 2022;104:106778). Int J Surg 2022; 106:106927. [PMID: 36152922 DOI: 10.1016/j.ijsu.2022.106927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/13/2022] [Indexed: 11/21/2022]
|
9
|
King WC, Hinerman AS, White GE. A 7-Year Study of the Durability of Improvements in Pain, Physical Function, and Work Productivity After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. JAMA Netw Open 2022; 5:e2231593. [PMID: 36103179 PMCID: PMC9475385 DOI: 10.1001/jamanetworkopen.2022.31593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Bariatric surgical procedures are associated with clinically important improvements (CIIs) in pain and physical function. However, there are declines in initial improvement by the third postoperative year, and the long-term durability of improvements are not well-described. OBJECTIVE To evaluate the durability of improvements in pain and physical function through 7 years after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). DESIGN, SETTING, AND PARTICIPANTS This study is part of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), a cohort study at 10 US hospitals. Adults with severe obesity (ie, body mass index of 35 or greater) undergoing bariatric surgery were assessed preoperatively (2006-2009) and followed up annually for as long as 7 years or until 2015. Of 1829 participants who underwent RYGB or SG in LABS-2, 338 were excluded from this study because they had a follow-up period of less than 5 years. Analysis of participants who underwent RYGB or SG and completed research assessments preoperatively and postoperatively for 5 to 7 years was conducted from March to April 2022. MAIN OUTCOMES AND MEASURES Preoperative-to-postoperative CIIs in pain and physical function scores from the 36-Item Short Form Health Survey and the Western Ontario McMaster Osteoarthritis Index, and 400-meter walk time, using previously established thresholds; and remission of mobility deficit, ie, inability to walk 400 meters in 7 minutes or less. RESULTS A total of 1491 individuals were included, with 1194 (80%) women; 59 (4%) Hispanic, 164 (11%) non-Hispanic Black, and 1205 (82%) non-Hispanic White individuals; a preoperative median (IQR) age of 47 (38-55) years; and a preoperative median (IQR) body mass index of 47 (42-52). Between 3 and 7 years after surgery, the percentage of participants with preoperative-to-postoperative CIIs in bodily pain decreased from 50% (95% CI, 48%-53%) to 43% (95% CI, 40%-46%), in physical function from 75% (95% CI, 73%-77%) to 64% (95% CI, 61%-68%), and in 400-meter walk time from 61% (95% CI, 56%-65%) to 50% (95% CI, 45%-55%). Among participants with a preoperative mobility deficit, remission decreased from 50% (95% CI, 42%-57%) to 41% (95% CI, 32%-49%), and among participants with severe knee or hip pain or disability, the percentage with CIIs in knee and hip pain and function decreased (eg, hip pain: from 77% [95% CI, 72%-82%] to 65% [95% CI, 58%-72%]; knee function: from 77% [95% CI, 73%-82%] to 72% [95% CI, 67%-77%]). CONCLUSIONS AND RELEVANCE In this cohort study, despite decreases in preoperative-to-postoperative improvements across follow-up, CIIs in perceived bodily and joint-specific pain and in self-reported and objectively measured physical function ranged from 41% to 72%, depending on the measure and subgroup, 7 years after surgery, suggesting that RYGB and SG are commonly associated with long-term CIIs in pain and physical function.
Collapse
Affiliation(s)
- Wendy C. King
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amanda S. Hinerman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Gretchen E. White
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
10
|
Gupta RK, Schwenk ES. Bariatric surgery and total knee/hip arthroplasty: an analysis of the impact of sequence and timing on outcomes: an infographic. Reg Anesth Pain Med 2021; 46:946. [PMID: 34493623 DOI: 10.1136/rapm-2021-103134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rajnish K Gupta
- Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric S Schwenk
- Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|