Benjamin R Childs           

 

Obesity is associated with more complications and longer hospital stays after orthopaedic trauma              

 

Childs, B. R., Nahm, N. J., Dolenc, A. J., & Vallier, H. A. (2015). Obesity is associated with more complications and longer hospital stays after orthopaedic trauma. Journal of Orthopaedic Trauma.   

 

 

Objective: The objective of this study is 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: 376 patients with an Injury Severity Score (ISS) 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 (BMI)>= 30)] versus non-obese patients included presence of pneumonia, deep vein thrombosis (DVT), 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% v 28.4%, p=0.03), with more acute renal failure (ARF) (5.70% v 1.38%, p=0.02), and infection (11.4% v 5.50%, p=0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 v 5.25 days, p=0.05; and 4.92 v 2.90 days, p=0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 v 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% v 16.1% p=0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in non-obese 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 BMI may help to improve outcomes and minimize additional treatment expenses.

 

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