Enforcing BMI Cutoffs for Shoulder Joint Surgery Could Exacerbate Disparities

WEDNESDAY, Aug. 2, 2023 (HealthDay News) -- Enforcing body mass index (BMI) cutoffs for access to total shoulder arthroplasty (TSA) may limit the procedure for female or Black patients across all BMI cutoffs, according to a study recently published in the Journal of Shoulder and Elbow Surgery.

Ronit Kulkarni, from the Medical University of South Carolina in Charleston, and colleagues assessed the implications of using BMI cutoffs (five cutoff values: 30, 35, 40, 45, and 50 kg/m²) on the eligibility for TSA among different ethnic and gender patient populations. The analysis included data from 20,872 patients who underwent anatomic and reverse TSA between 2015 and 2019.

The researchers found that for all BMI subgroups, there were significantly more ineligible than eligible patients who were female or Black. In each BMI cutoff group, the relative rate of eligibility for Black patients was lower, whereas the relative rate of eligibility for White and Asian patients was higher. For BMI cutoffs of 30 kg/m² and 35 kg/m², there were more eligible than ineligible Asian patients, and there were no significant differences in eligibility and ineligibility in Hispanic patients. White patients were significantly more eligible than ineligible for all BMI cutoff groups.

"Physicians may inadvertently increase health care disparities observed in TSA if they use BMI as the sole risk stratification tool for patients, even though BMI has been known to increase complications after TSA," the authors write.

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