Thromboembolic risks after knee arthroplasty in patients with severe obesity: A large-scale analysis using Japanese medical claims data.

Background: Obesity is associated with an increased risk of complications after total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA), particularly in Western populations. However, the effect of severe obesity (body mass index [BMI] ≥ 35 kg/m²) on postoperative complications in Japanese patients remains unclear.

Methods: We conducted a retrospective cohort study using Japan's Diagnosis Procedure Combination (DPC) database, including patients who underwent TKA or UKA between April 2016 and March 2023. Patients were classified into severely obese (BMI ≥35 kg/m²) and non-severely obese (BMI <35 kg/m²) groups. After 1:1 propensity score matching for age, sex, comorbidities, surgical method, and Charlson Comorbidity Index, postoperative complications were compared using chi-square tests and multivariate logistic regression analyses.

Results: A total of 7832 matched pairs were analyzed. The incidence of deep vein thrombosis (odds ratio [OR], 1.16; 95 % confidence interval [CI], 1.03-1.29; p = 0.011) and pulmonary embolism (OR, 1.79; 95 % CI, 1.03-3.10; p = 0.037) was significantly higher in the severely obese group. Simultaneous bilateral surgery was also an independent risk factor for venous thromboembolism (VTE). No significant differences were observed in surgical site infection, length of hospital stay, or transfusion volume between the two groups.

Conclusions: Severe obesity and simultaneous bilateral surgery are independent risk factors for VTE following knee arthroplasty in Japanese patients. These findings highlight the need for careful perioperative management in this high-risk population.