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Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma

Childs, Benjamin R. BS*; Nahm, Nickolas J. MD*; Dolenc, Andrea J. BS*; Vallier, Heather A. MD*

doi: 10.1097/BOT.0000000000000324
Original Article
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Objective: The objective of this study was to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures.

Design: Prospective, observational.

Setting: Level 1 trauma center.

Patients: Three hundred seventy-six patients with an Injury Severity Score greater than 16 and mechanically unstable high-energy fractures of the femur, pelvic ring, acetabulum, or spine requiring stabilization.

Main Outcome Measurements: Data for obese (body mass index ≥ 30) versus nonobese patients included presence of pneumonia, deep vein thrombosis, pulmonary embolism, infection, organ failure, and mortality. Days in ICU and hospital, days on ventilator, transfusions, and surgical details were documented.

Results: Complications occurred more often in obese patients (38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs. 1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs. 2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P = 0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03).

Conclusions: Obesity was noted among 42% of our trauma patients. In obese patients, complications occurred more often and hospital and ICU stays were significantly longer. These increases are likely to be associated with greater hospital costs. Surgeon decision to delay procedures in medically stable obese patients may have contributed to these findings; definitive fixation was more likely to be delayed in obese patients. Further study to optimize the care of patients with increased body mass index may help to improve outcomes and minimize additional treatment expenses.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Supplemental Digital Content is Available in the Text.

*Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

Reprints: Heather A. Vallier, MD, Department of Orthopaedic Surgery, 2500 MetroHealth Drive, Cleveland, OH 44109 (e-mail: hvallier@metrohealth.org).

Presented as a poster at the Annual Meeting of the Orthopaedic Trauma Association, October 2013, Phoenix, AZ.

The authors report no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com).

The MetroHealth IRB approved this study.

Accepted February 26, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.