Influence of Obesity on Outcomes of Hallux Valgus Corrective Surgery

NewsBot · Mar 25, 2015

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The Influence of Obesity on Outcomes of Hallux Valgus Corrective Surgery
Yong Qiang Jerry Chen, MBBS, Singapore, Singapore
Merrill Lee, MBBS, Singapore, Singapore
Hwei Chi Chong, Singapore, Singapore
Inderjeet S. Rikhraj, MD, Singapore, Singapore
Presented at AAOS Annual Meeting; March 2015

INTRODUCTION: Obesity is a global epidemic with more than 502 million people classified as obese
worldwide. It affects bones and soft tissues at both the biomechanical and biochemical levels.
Biomechanically, obesity leads to excessive load across weightbearing joints. Biochemically, the
increased fat-derived adipokines results in a chronic low-grade inflammation linked to perioperative
infection, poor wound healing, thromboembolic events, and cardiopulmonary complications. While
obesity is known to be associated with poorer postoperative fucntional outcome scores in rotator cuff
repairs and arthroplasty surgeries, its influence on foot and ankle surgeries is not as well-defined. This
study aims to investigate the influence of obesity on the perioperative complication rates and functional
outcome scores in hallux valgus corrective surgery.
METHODS: This study was approved by the hospital’s ethics committee. Between January 2007 and
December 2011, 523 patients underwent hallux valgus corrective surgery at the Foot and Ankle Division
of a tertiary institution. The patients were prospectively followed up for two years and functional
outcome was assessed using the American Orthopaedic Foot and Ankle Society Hallux
Metatarsophalangeal-Interphalangeal Scale (AOFAS MTP-IP) and Visual Analogue Scale (VAS) for hallux
pain. Incidences of surgical site infection (SSI) and revision surgery were also recorded. Statistical
analysis was carried out by categorizing the patients into two groups based on Body Mass Index (BMI):
1) BMI < 30 kg/m2 (Control); 2) BMI ≥ 30 kg/m2 (Obese). The Mann-Whitney U test was used to
compare the two groups for quantitative variables while the Pearson Chi-Square test was used for
categorical variables.
RESULTS: Eleven percent of the patients were obese. There was no significant difference in the duration
of surgery, length of hospital stay, and incidence of SSI between the two groups. However, the
proportion of obese patients who required revision surgery was significantly higher than those with a
normal BMI. Although obese patients have lower preoperative AOFAS MTP-IP, the postoperative score
was comparable with those with a normal BMI (Table 1).
DISCUSSION AND CONCLUSION: Although the prevalence of hallux valgus is more common in patients
with a normal BMI than obese patients, those obese patients diagnosed with hallux valgus have poorer
preoperative functional outcome scores compared to their couterparts with normal BMI. In this study,
obese patients also have higher risk of revision surgery but similar improvement in functional outcome
scores compared to those with a normal BMI. The overall improvement in function should be the
barometer of success. While it is important to warn obese patients of the significant increase in risk for
revision surgery, these patients should not be excluded from the benefits of undergoing hallux valgus
corrective surgery.
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NewsBot · Apr 17, 2015

Effect of Obesity on Outcome of Hallux Valgus Surgery
Jerry Yongqiang Chen, Merrill Jian Hui Lee, Kiran Rikhraj, Simran Parmar, Hwei Chi Chong, Andy Khye Soon Yew, Kevin Oon Thien Koo, Inderjeet Singh Rikhraj
Foot & Ankle International April 16, 2015

Background: Obesity is a global epidemic, but its effect on foot and ankle surgeries is not well defined. This study aimed to investigate the influence of obesity on functional outcome scores, incidence of postoperative surgical site infection (SSI), and repeat surgery after hallux valgus (HV) corrective surgery.
Methods: Between January 2007 and December 2011, 452 patients who underwent HV corrective surgery at a tertiary hospital were evaluated. They were categorized into 2 groups based on their body mass index (BMI): (1) BMI less than 30 kg/m2 (control); (2) BMI 30 kg/m2 or more (obese). The patients were prospectively followed for 2 years.
Results: Patients in the obese group were significantly older by 4 years (95% CI, 1-7 years) (P = .043). The preoperative American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal-Interphalangeal (AOFAS Hallux MTP-IP) Scale and Physical Component Score were 6 points (95% CI, 1-11 points) and 3 points (95% CI, 1-6 points) poorer, respectively, in the obese group (P = .014 and P = .032, respectively). However, the Visual Analog Scale, AOFAS Hallux MTP-IP Scale, Physical Component Score, and Mental Component Score were comparable between the 2 groups at 6 months and 2 years of follow-up (all P > .05). Eleven patients (3%) in the control group and 1 patient in the obese group (2%) developed postoperative SSI (P = .777). Nine patients (2%) in the control group and 7 patients in the obese group (14%) required repeat surgery for complications (P < .001).
Conclusion: The authors conclude that while it is important to warn obese patients of the significantly higher risk of repeat surgery, these patients should not be excluded from undergoing HV surgery.
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NewsBot · Jan 8, 2016

Effect of Obesity on Outcomes of Forefoot Surgery
Matthew S. Stewart et al
Foot & Ankle International January 7, 2016

Background: Forefoot surgery typically is elective, so it is important to define risk factors to educate patients on potential complications. The purpose of this study was to determine if obesity is an independent risk factor that contributes to increased complication rates after forefoot surgery.
Methods: Through a retrospective review of records, 633 patients were identified who had forefoot surgery at one institution between 2008 and 2010. All patients who currently smoked or smoked in the past were excluded to eliminate a confounding factor, as smoking is known to increase complication rates, leaving 427 patients for inclusion, 299 nonobese (BMI less than 30) and 128 obese (BMI more than 30). Medical records were reviewed for the occurrence of complications, including nonunion, delayed union, delayed wound healing, infection, and persistent pain.
Results: The overall complication rate was 9%, with similar rates between obese (10%) and nonobese patients (9%). The only specific complication approaching significance (P = .13) was a higher rate of infection in obese patients (4 % compared to 1%), which could be attributed to the higher percentage of diabetic patients in the obese group. Diabetic patients, regardless of weight, had significantly higher rates of infection (P = .03), with a trend toward higher rates of overall complications and delayed wound healing (P = .08 and P < .06, respectively).
Conclusion: Obesity was not shown to lead to more frequent complications after forefoot surgery. Diabetes was associated with significantly higher rates of infection, regardless of weight. Though not significant, there was a trend toward higher rates of overall complications and delayed wound healing in diabetic patients as well.
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NewsBot · Oct 16, 2019

The influence of obesity and gender on outcome after reversed L-shaped osteotomy for hallux valgus
Stephan H. Wirth, Niklas Renner, Richard Niehaus, Jan Farei-Campagna, Marcel Deggeller, Fabrice Scheurer, Katie Palmer & Thorsten Jentzsch
BMC Musculoskeletal Disorders volume 20, Article number: 450 (2019)

Background
Hallux valgus deformity (HV) affects around every fourth individual, and surgical treatment is performed in every thousandth person. There is an ongoing quest for the best surgical management and reduction of undesirable outcomes. The aim was to explore associations of obesity and gender with radiological and clinical outcome after reversed L-shaped osteotomy (ReveL) for HV.

Materials and methods
This study was carried out in a retrospective cohort design at a single University Hospital in Switzerland between January 2004 and December 2013. It included adult patients treated with ReveL for HV. The primary exposure was body mass index (BMI) at the time of ReveL. The secondary exposure was gender. The primary outcome was radiological relapse of HV (HV angle [HVA] > 15 degrees [°]) at the last follow-up. Secondary outcomes were improvable patient satisfaction, complication, redo surgery, and optional hardware removal. Logistic regression analysis adjusted for confounders.

Results
The median weight, height, and BMI were 66.0 (interquartile range [IQR] 57.0–76.0) kilograms (kg), 1.65 (IQR 1.60–1.71) metres (m), and 24.0 (IQR 21.3–27.8) kg/m2. Logistic regression analysis did not show associations of relapse with BMI, independent of age, gender, additional technique, and preoperative HVA (adjusted odds ratio [ORadjusted] = 1.10 [95% (%) confidence interval (CI) = 0.70–1.45], p = 0.675). Relapse was 91% more likely in males (ORadjusted = 1.91 [95% CI = 1.19–3.06], p = 0.007). Improvable satisfaction was 79% more likely in males (ORadjusted = 1.79 [CI = 1.04–3.06], p = 0.035). Hardware removal was 47% less likely in males (ORadjusted = 0.53 [95% CI 0.30–0.94], p = 0.029).

Conclusions
In this study, obesity was not associated with unsatisfactory outcomes after ReveL for HV. This challenges the previous recommendation that preoperative weight loss may be necessary for a successful surgical treatment outcome. Males may be informed about potentially higher associations with unfavourable outcomes. Due to the risk of selection bias and lack of causality, findings may need to be confirmed with clinical trials.
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NewsBot · Mar 15, 2021

The Influence of Obesity on Hospital Admission After Outpatient Foot and Ankle Surgery
Brittany N. Burton, MD, MHS, MAS
JFAS: March 05, 2021

We examined the association of body mass index (BMI) with sociodemographic data, medical comorbidities and hospital admission following ambulatory foot and ankle surgery. We conducted an analysis utilizing data from the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2016. Adult patients who underwent ankle surgery defined as ankle arthrodesis, ankle open reduction and internal fixation, and Achilles tendon repair in the outpatient setting. We examined 6 BMI ranges: <20 kg/m 2 underweight, ≥20 to < 25kg/m 2 normal weight, ≥25 to < 30 kg/m 2 overweight, ≥30 to < 40 kg/m 2 obese, ≥40 kg/m 2 to < 50 kg/m2 severely obese, and ≥ 50 kg/m 2 extremely obese. The primary outcome was hospital admission. We performed multivariable logistic regression and reported odds ratios (OR) and their associated 95% confidence interval (CI) and considered a p-value of <0.05 as statistically significant. Data extraction yielded 13,454 adult patients who underwent ambulatory ankle surgery. We then performed listwise deletion to exclude cases with missing observations. After excluding 5.4% of the data, the final study population included 12,729 patients. The overall rate of hospital admission was in the population was 18.6% (2,377/12,729). The overall rate of postoperative complications was 0.03% (4/12,729). We found no significant association of BMI with hospital admission following multivariable logistic regression. We recommend that BMI alone should not be solely used to exclude patients from having ankle surgery performed in an outpatient setting, especially since this patient group makes up a significant proportion of orthopedic surgery.
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