P S Whiting1, G A White-Dzuro2, F R Avilucea3, A C Dodd2, N Lakomkin2, W T Obremskey2, C A Collinge2, M K Sethi4. 1. Department of Orthopaedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave., Madison, WI, 53705, USA. 2. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA. 3. Department of Orthopaedic Surgery, University of Cincinnati Academic Health Center, P.O. Box 670212, Cincinnati, Ohio, 45267-0212, USA. 4. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA. manish.sethi@vanderbilt.edu.
Abstract
PURPOSE: The impact of obesity on outcomes has been documented extensively in the elective orthopaedic literature, but little is known about the impact of obesity on outcomes following orthopaedic trauma surgery. Utilizing the ACS-NSQIP database, we sought to investigate the relationship between BMI and perioperative complications in orthopaedic trauma patients. METHODS: 53,219 orthopaedic trauma patients were identified using a CPT code search between 2005 and 2013 in the NSQIP database. Patient demographics, and perioperative complications (including minor, major, and total) were collected. Multivariate regression analysis was performed to control for baseline demographics and comorbidities. RESULTS: Compared with patients of normal weight, underweight patients had significantly greater odds of minor [OR 1.12, 95 % CI (1.0, 1.26), p = 0.04], major [OR 1.20, 95 % CI (1.1, 1.3), p = 0.0009], and total complications [OR 1.18, 95 % CI (1.1, 1.3), p = 0.0003]. Morbidly obese patients had significantly greater odds of major [OR 1.22, 95 % CI (1.0, 1.5), p = 0.023] and total complications [OR 1.18, 95 % CI (1.0, 1.4), p = 0.023] compared to normal weight patients. When wound-related complications were examined independently, obesity was associated with increased odds of superficial [OR 1.67, 95 % CI (1.3, 2.1), p < 0.0001] and deep wound infection [OR 1.52, 95 % CI (1.075, 2.144), p = 0.018], and morbid obesity was associated with increased odds of wound dehiscence [OR 2.29, 95 % CI (1.1, 4.9), p = 0.034] and deep infection [OR 2.51, 95 % CI (1.6, 3.9), p < 0.0001]. CONCLUSIONS: Morbidly obese patients have significantly greater odds of wound dehiscence, deep wound infection, major complications, and total complications compared to patients of normal weight. Additionally, BMI under 18.5 is associated with increased odds of minor, major, and total perioperative complications. Interventions aimed at decreasing complication rates should be targeted at these high-risk patient populations on both ends of the BMI spectrum.
PURPOSE: The impact of obesity on outcomes has been documented extensively in the elective orthopaedic literature, but little is known about the impact of obesity on outcomes following orthopaedic trauma surgery. Utilizing the ACS-NSQIP database, we sought to investigate the relationship between BMI and perioperative complications in orthopaedic traumapatients. METHODS: 53,219 orthopaedic traumapatients were identified using a CPT code search between 2005 and 2013 in the NSQIP database. Patient demographics, and perioperative complications (including minor, major, and total) were collected. Multivariate regression analysis was performed to control for baseline demographics and comorbidities. RESULTS: Compared with patients of normal weight, underweight patients had significantly greater odds of minor [OR 1.12, 95 % CI (1.0, 1.26), p = 0.04], major [OR 1.20, 95 % CI (1.1, 1.3), p = 0.0009], and total complications [OR 1.18, 95 % CI (1.1, 1.3), p = 0.0003]. Morbidly obesepatients had significantly greater odds of major [OR 1.22, 95 % CI (1.0, 1.5), p = 0.023] and total complications [OR 1.18, 95 % CI (1.0, 1.4), p = 0.023] compared to normal weight patients. When wound-related complications were examined independently, obesity was associated with increased odds of superficial [OR 1.67, 95 % CI (1.3, 2.1), p < 0.0001] and deep wound infection [OR 1.52, 95 % CI (1.075, 2.144), p = 0.018], and morbid obesity was associated with increased odds of wound dehiscence [OR 2.29, 95 % CI (1.1, 4.9), p = 0.034] and deep infection [OR 2.51, 95 % CI (1.6, 3.9), p < 0.0001]. CONCLUSIONS: Morbidly obesepatients have significantly greater odds of wound dehiscence, deep wound infection, major complications, and total complications compared to patients of normal weight. Additionally, BMI under 18.5 is associated with increased odds of minor, major, and total perioperative complications. Interventions aimed at decreasing complication rates should be targeted at these high-risk patient populations on both ends of the BMI spectrum.
Authors: Linda I Suleiman; Gezzer Ortega; Sharon K Ong'uti; Dani O Gonzalez; Daniel D Tran; Aham Onyike; Patricia L Turner; Terrence M Fullum Journal: J Surg Res Date: 2011-06-25 Impact factor: 2.192
Authors: Aslam Ejaz; Gaya Spolverato; Yuhree Kim; George A Poultsides; Ryan C Fields; Mark Bloomston; Clifford S Cho; Konstantinos Votanopoulos; Shishir K Maithel; Timothy M Pawlik Journal: J Surg Res Date: 2014-12-31 Impact factor: 2.192
Authors: Tabita M Valentijn; Wael Galal; Elke K M Tjeertes; Sanne E Hoeks; Hence J Verhagen; Robert Jan Stolker Journal: Surgeon Date: 2013-03-09 Impact factor: 2.392
Authors: Gino M M J Kerkhoffs; Elvire Servien; Warren Dunn; Diane Dahm; Jos A M Bramer; Daniel Haverkamp Journal: J Bone Joint Surg Am Date: 2012-10-17 Impact factor: 5.284
Authors: John A Batsis; James M Naessens; Mark T Keegan; Amy E Wagie; Paul M Huddleston; Jeanne M Huddleston Journal: Public Health Nutr Date: 2009-03-12 Impact factor: 4.022
Authors: Kristina A Giles; Allen D Hamdan; Frank B Pomposelli; Mark C Wyers; Jeffrey J Siracuse; Marc L Schermerhorn Journal: Ann Vasc Surg Date: 2009-07-19 Impact factor: 1.466
Authors: Tiffany A Radcliff; William G Henderson; Tamara J Stoner; Shukri F Khuri; Michael Dohm; Evelyn Hutt Journal: J Bone Joint Surg Am Date: 2008-01 Impact factor: 5.284
Authors: Hannah E Rosenfeld; Rebecca Limb; Patrick Chan; Mark Fitzgerald; William Pierre Litherland Bradley; Jeffrey V Rosenfeld Journal: J Neurosurg Spine Date: 2013-05-21
Authors: Andrew J Pugely; Christopher T Martin; Yubo Gao; Sergio Mendoza-Lattes; John J Callaghan Journal: J Bone Joint Surg Am Date: 2013-02-06 Impact factor: 5.284
Authors: Daniel L Davenport; Eleftherios S Xenos; Patrick Hosokawa; Jacob Radford; William G Henderson; Eric D Endean Journal: J Vasc Surg Date: 2008-11-22 Impact factor: 4.268
Authors: Peter J Ostergaard; Matthew A Tarabochia; Matthew J Hall; George Dyer; Brandon E Earp; Philip Blazar; Dafang Zhang Journal: Clin Orthop Relat Res Date: 2021-01-01 Impact factor: 4.755
Authors: Biswajit Khatua; Bara El-Kurdi; Krutika Patel; Christopher Rood; Pawan Noel; Michael Crowell; Jordan R Yaron; Sergiy Kostenko; Andre Guerra; Douglas O Faigel; Mark Lowe; Vijay P Singh Journal: Sci Adv Date: 2021-01-29 Impact factor: 14.136