September 23, 2025
2 min read
Key takeaways:
- Utilizing a BMI cutoff for total ankle arthroplasty did eliminate patients with complications.
- However, more patients who did not have complications were eliminated than those with complications.
Using a BMI cutoff for total ankle arthroplasty may restrict access to care for patients who would do well with surgery, according to data presented here.
“There is a large stigma against obesity, but in a lot of circumstances those patients struggle to lose weight,” Nicole Huang, MD, PGY-4 resident at Loyola Medicine, told Healio about results presented at the American Orthopaedic Foot & Ankle Society Annual Meeting. “The study shows that increased BMI does not necessarily correlate to increased complications. There are a large number of patients that do not have any complications after surgery, despite having a higher BMI.”
Huang and colleagues collected 30 days of postoperative data from a national database of more than 3,000 patients who underwent total ankle arthroplasty. Researchers retrospectively applied a BMI cutoff to determine whether or not patient outcomes could be optimized by eliminating patients with comorbidities and complications.
Nicole Huang
“Basically, the idea was if you were to use a BMI cutoff in this database that has already had patients who had surgery, were you able to properly eliminate patients who had complications, or were you eliminating an unnecessary amount of people who did not have complications above the cutoff,” Huang said.
Overall, Huang said there were 165 complications among 109 patients. Although utilizing the BMI cutoff eliminated patients with complications, Huang said more patients were eliminated who did not have complications.
After applying a BMI cutoff of 35 kg/m2, Huang and colleagues found 0.8% (n = 24) of patients would have avoided surgery with a complication, while 23% (n = 694) of patients would have been denied complication-free surgery.
“One of the reasons that we as a medical community limit surgeries like this on [patients with obesity] is that we think they are at a higher risk for complications,” Adam P. Schiff, MD, foot and ankle surgeon at Loyola Medicine and co-author on the study, told Healio. “What this study highlights is that even though they may be at risk for complications, the vast majority of patients are still having successful surgery without complications. And by strictly saying, ‘you are not having surgery because you are obese,’ you are restricting care to numerous patients who would do very well with surgery.”
Huang said it may be worthwhile to repeat the study in a large, multi-institutional population over a longer period of time postoperatively.
For more information:
Nicole Huang, MD, and Adam P. Schiff, MD, wish to be contacted through Margaret Coty at mcoty@lumc.edu.
Sources/Disclosures
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Huang N, et al. Restricting access to care by using body mass index as eligibility criteria for total ankle arthroplasty. Presented at: American Orthopaedic Foot & Ankle Society Annual Meeting; Sept. 10-13, 2025; Savannah, Ga.
Disclosures:
Huang and Schiff report no relevant financial disclosures.
