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World J Clin Cases. Sep 6, 2026; 14(25): 125054
Published online Sep 6, 2026. doi: 10.12998/wjcc.125054
Obesity and postoperative opioid utilization after total knee arthroplasty: A propensity-matched analysis
Kevin A Wu, Eric Mai, Christopher S Warburton, Suraj Dhanjani, Ankit Choudhury, Francesca Docters, Laurel Wong, Anjali Prabhat, Marium Raza, Omri Maayan, Junho Song, Michael Shatkin, Calin S Moucha, Brett L Hayden
Kevin A Wu, Eric Mai, Christopher S Warburton, Suraj Dhanjani, Anjali Prabhat, Marium Raza, Omri Maayan, Junho Song, Michael Shatkin, Brett L Hayden, Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Ankit Choudhury, Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Francesca Docters, Laurel Wong, Icahn School of Medicine at Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Calin S Moucha, Leni and Peter W. May Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY 10029, United States
Author contributions: Wu KA conceived and designed the study and drafted the manuscript; Choudhury A performed the data acquisition, statistical analysis, and assisted with manuscript drafting and editing; Mai E, Warburton CS, Dhanjani S, Docters F, Wong L, Prabhat A, Raza M, Maayan O, Song J and Shatkin M contributed to data interpretation and manuscript revision; Moucha CS and Hayden BL supervised the study and provided critical revision of the manuscript; and all authors read and approved the final manuscript.
AI contribution statement: No artificial intelligence tools were used in the preparation of this manuscript.
Institutional review board statement: This retrospective cohort study used de-identified patient data from a national database and did not require Institutional Review Board approval.
Informed consent statement: This study used de-identified data, did not require IRB approval, and informed consent was not required.
Conflict-of-interest statement: The authors declare no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Data sharing statement: The data that support the findings of this study are derived from a third-party de-identified electronic health record database and are not publicly available due to data-use restrictions. De-identified data may be available from the corresponding author upon request and subject to database permissions.
Corresponding author: Kevin A Wu, MD, Researcher, Department of Orthopedics, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, New York, NY 10029, United States.
kevin.wu2@mountsinai.org
Received: July 7, 2026
Revised: July 31, 2026
Accepted: August 20, 2026
Published online: September 6, 2026
Processing time: 66 Days and 11.1 Hours
BACKGROUND
Obesity is associated with increased complications following total knee arthroplasty (TKA), but its relationship with postoperative opioid prescribing remains unclear. Understanding whether body mass index (BMI) independently influences opioid prescribing patterns may help guide postoperative pain management and opioid stewardship strategies.
AIM
To evaluate the association between BMI and postoperative opioid prescribing following primary TKA.
METHODS
A retrospective cohort study was performed from March 2005 to March 2024 including adult patients undergoing primary TKA without prior opioid prescriptions. Patients were stratified into BMI cohorts: < 30 kg/m², 30-34.9 kg/m², 35-39.9 kg/m², and ≥ 40 kg/m², with additional grouped comparisons including BMI ≥ 30 kg/m² vs < 30 kg/m² and BMI ≥ 40 kg/m² vs < 40 kg/m². Six direct comparisons were performed between BMI groups. Propensity score matching (1:1) was conducted based on demographic factors and comorbidities including age, sex, race, mood disorders, anxiety disorders, chronic pain conditions, diabetes, hyperlipidemia, hypertension, chronic kidney disease, nicotine dependence, and coronary artery disease. Opioid prescriptions within 2 years following TKA were assessed using odds ratios (ORs) with 95%CI. The number of postoperative opioid prescriptions was also compared between groups.
RESULTS
A total of 12830 opioid-naive patients undergoing primary TKA were identified, from which BMI-defined cohorts were derived. Patients with BMI ≥ 30 kg/m² were more likely to receive postoperative opioid prescriptions compared to those with BMI < 30 kg/m² (OR: 1.174; 95%CI: 1.056-1.305; P = 0.003). However, patients with BMI ≥ 40 kg/m² were not significantly more likely to receive opioid prescriptions compared to patients with BMI < 40 kg/m², BMI < 30 kg/m², BMI 30-34.9 kg/m², or BMI 35-39.9 kg/m². Additionally, no significant difference was observed between BMI 35-39.9 kg/m² and BMI 30-34.9 kg/m². There were no significant differences in the total number of postoperative opioid prescriptions across any BMI comparison.
CONCLUSION
While patients with BMI ≥ 30 kg/m² demonstrated a slightly increased likelihood of receiving postoperative opioid prescriptions following TKA, increasing levels of obesity were not associated with higher opioid prescribing rates or greater numbers of prescriptions. These findings suggest BMI alone may not be a major driver of postoperative opioid prescribing following TKA.
Core Tip: This large propensity-matched national cohort study examined how body mass index (BMI) relates to opioid prescribing after primary total knee arthroplasty (TKA) in opioid-naive patients. Patients with obesity (BMI 30 kg/m² or greater) had a modestly higher likelihood of receiving postoperative opioid prescriptions, but greater obesity severity, including morbid obesity (BMI 40 kg/m² or greater), was not associated with more prescriptions. BMI alone may therefore be a limited predictor of postoperative opioid prescribing after TKA, and individualized evaluation of psychosocial and pain-related risk factors may better guide opioid stewardship.
