Background

Of the 24 million Americans with morbid obesity, 0.9% received surgical treatment in 2016. Based on our previous studies, a new referral program, the Total Joint Arthroplasty Care Collaborative (TACC), was initiated between a community bariatric practice and a total joint program. The aim of our current study is to investigate the implementation of TACC and determine if it improves access to treatment for obesity.

Methods

A retrospective comparative cohort analysis of total joint patients referred to a bariatric program was performed comparing the number of referrals received from 2015-2017 during standard referral practices (SRP) to those received since 2018 during TACC. Outcomes analyzed included number of: referrals, bariatric consults, patients undergoing medical weight management (MWM), and patients undergoing bariatric surgery. Differences in rates were assessed using a Chi-square test.

Results

There were 327 referrals (109/year) for SRP and 188 (150/year) for TACC. There were 72 bariatric consults (22%) for SRP and 89 (47%) for TACC (p<0.001). 25 SRP patients (7.6%) and 26 TACC patients (13.8%) received MWM (p<0.031). The proportion of patients having bariatric surgery has increased 3.1% (10) for SRP and 5.3% (10) for TACC with 10 more patients in the pathway.

Conclusions

TACC has resulted in an increase in referrals, a significant increase in bariatric consults, a significant increase in patients receiving MWM, and an increase in bariatric surgery compared to SRP. Results will be updated as on-going patient accrual continues. Phase III of this project will evaluate surgical optimization and total joint arthroplasties performed.