By Epaminondas Markos Valsamis
Last year we told the tale of ‘Mr C’ - a plump, jolly chap whose years of hoisting sacks and guiding reindeer had worn out his shoulder joint.
The news was initially good and ‘Mr C’ joined a waiting list for a shoulder replacement so he could continue his seasonal work. That is, until a group of over-zealous gatekeepers denied him surgery, citing their strict high-BMI exclusion policy.
It’s no secret that ‘Mr C’ has always been a portly fellow. His round belly shakes like a bowlful of jelly when he laughs, and a lifetime of mince pies has likely nudged his body-mass index (BMI) into the ‘high’ category.
But despite assumptions, the evidence linking higher BMI to worse outcomes after shoulder replacement is weak. Nonetheless, he found himself turned away - “Scrooge-style rationing”, he muttered. But rather than giving up on his wish list - the one that included a new shoulder to carry on delivering toys - he waited patiently for some good news.
That news finally arrived. In a study published in PLOS Medicine in November, NDORMS researchers analysed over 20,000 elective primary shoulder replacement surgeries across the UK and Denmark to investigate the association between BMI and patient outcomes after surgery.
Their findings were music to ‘Mr C’s’ ears, like jingling bells. Rather than showing an increased risk, the study found that patients with obesity (BMI 40 kg/m²) actually had a 60 per cent lower risk of death within a year compared with those with a “normal” BMI of 21.75 kg/m².
Meanwhile, those at the other end of the scale - underweight patients - fared worst, with a modestly higher risk of death and complications after surgery.
In short: a high BMI – even one as generous as our favourite gift-bearer’s – was not associated with worse outcomes after surgery. The data suggest there is no justification for blanket BMI-based restrictions on shoulder replacement surgery.
Lead author Epaminondas Markos Valsamis said that: 'Our findings make it clear: a patient’s size alone shouldn’t carry more weight than the evidence. ‘Mr C’, and patients like him, can step back into the queue knowing the evidence is on their side.'
And while this year might be too late to squeeze in the much-needed surgery, as ‘Mr C’ is well into the busy work of making a list and checking it twice for this year’s deliveries, maybe next year he’ll be looking forward to a pain-free, reindeer-powered Christmas Eve run!