Inferior clinical outcomes after femur fracture in the obese are potentially preventable

Bryant, Mary K.; Parrish, Matthew; Roy, Sara; Udekwu, Pascal; Farrell, Mary Beth; Schinco, Miren A.; Ganga, Sarat

doi:10.1016/j.injury.2019.08.026

Cited by 5 publications

(8 citation statements)

References 19 publications

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“…Other studies investigated the early and long-term mobilization and functionality after hip arthroplasty. Our results are in line with Bryant et al, showing a faster “out of bed” mobilization for NW and OW patients [ 24 ], while Busato et al reported better mobility in NW and OW patients [ 29 ]. Both studies showed a linear decrease of functionality with minimally higher BMI levels.…”

Section: Discussionsupporting

confidence: 92%

“…The reason for the prolonged hospitalization of OB patients was most probably delayed mobilization. Bryant et al showed a delayed time until the first mobilization out of bed for OB patients [ 24 ]. Our findings are in line with these results.…”

Section: Discussionmentioning

confidence: 99%

“…However, BMI could not be verified as a risk factor for early postoperative complications. Comparable studies by Batsis et al [ 12 ], Tucker et al [ 18 ], and Bryant et al [ 24 ] presented patient collectives with OB patient rates of 8.8%, 21%, and 29%, respectively. Shaparin et al described an obesity rate of 45%, with 18% reaching obesity grades II or III (BMI > 35 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

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The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

Müller

Gutwerk

Greve

et al. 2020

JCM

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Background: Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. Methods: In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient’s ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO’s BMI groups. Results: The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 ± 4.8 days), normal (13.6 ± 7.8 days), overweight (14.2 ± 11.7 days), and obese patients (16.0 ± 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 ± 42.9 min; normal weight = 90.2 ± 38.2 min; overweight = 99.9 ± 39.9 min; obese = 117.2 ± 61.5 min (p < 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5–30 kg/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient’s ability to walk on crutches. Conclusion: Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

Müller

Gutwerk

Greve

et al. 2020

JCM

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“…In corroboration with our finding that OB, SO, and MO BMI, as opposed to NW BMI, are risk factors for developing at least one complication, literature suggests that high BMI is a risk factor for several negative health outcomes following injury [ 15 – 17 ]. Pierpont et al reported that high adiposity, which is associated with high BMI, may lead to diminished capillary density and widespread vascular insufficiencies.…”

Section: Discussionsupporting

confidence: 91%

The impact of BMI on morbidity and mortality after femoral fractures

Soliman

Jordan

Bilaniuk

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Femur fractures are the result of high energy injury and are associated with life-threatening complications. Therefore, we studied how body mass index (BMI) contributes to complications after femoral fractures. Methods Using the 2016 American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) database, we stratified 41,362 patients into groups based on their BMI: Normal Weight (NW), Overweight (OW), Obese (OB), Severely Obese (SO), and Morbidly Obese (MO). We compared each BMI group to the NW cohort for differences in demographic factors, comorbidities, complications, and mechanism of injury. Results OB, SO, and MO patients sustained higher rates of traumatic injury from high energy mechanisms, such as motor vehicle trauma, in comparison to NW patients, who sustained more injuries from falls ( p < 0.05). Correspondingly, obese patients were more likely than NW patients to sustain shaft and distal end fractures ( p < 0.05). At hospital admission, obese patients presented with more comorbidities, such as bleeding disorders, congestive heart failure, diabetes mellitus, and hypertension ( p < 0.05). Despite these individual findings, patients with OB, SO, and MO BMI, as opposed to NW BMI, were independently associated with a higher probability of developing at least one post-trauma complication. More specifically, MO patients were associated with a 45% higher odds of developing a complication ( p < 0.05). Conclusion Irrespective of presenting with more comorbidities and sustaining high energy injuries, OB, SO, and MO patients were independently associated with having a higher risk of developing complications following a femoral fracture. Overall, better clinical outcomes are observed among patients with no underlying conditions and normal BMI.

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“…Early mobilization is required to gain mobility and minimize morbidity especially in obese patients as higher Body Mass Index (BMI) increases the risk of longer hospital stays and systemic complications in polytrauma patients. 54…”

Section: Obesitymentioning

confidence: 99%

Evolving concepts and strategies in the management of polytrauma patients

Upadhyaya

Iyengar

Jain

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Major trauma is one of the leading causes of morbidity and mortality in young adults. The impact of disability on the quality of life and functionality in this younger population is worrisome. This remains a major public health concern across the globe. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury to the first few days, usually because of traumatic brain injury or major exsanguination and subsequently due to shock or hypoxia. Worldwide adoption of comprehensive trauma systems and evolving models of trauma care including prehospital interventions have led improvements in trauma and critical care over the last few decades. Resuscitation and damage control orthopaedics are two key pillars in the management of polytrauma patient. Traumarelated coagulopathy can be an emerging complication during resuscitation of such patients which should be recognized early so appropriate corrective measures can be undertaken. We describe the evolving models of care in the management of polytrauma and trauma associated coagulopathy.

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Inferior clinical outcomes after femur fracture in the obese are potentially preventable

Cited by 5 publications

References 19 publications

The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

The impact of BMI on morbidity and mortality after femoral fractures

Evolving concepts and strategies in the management of polytrauma patients

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