Obesity Increases Early Complications After High-Energy Pelvic and Acetabular Fractures

Abstract

Elevated body mass index has been identified as a potential risk factor for complications in operatively treated pelvic trauma. Although obesity is an independent risk factor for morbidity and mortality following high-energy blunt force trauma, there is little information on the immediate complications following isolated pelvic and acetabular fractures in obese patients with trauma. The authors hypothesized that obesity (body mass index ≥30 kg/m(2)) is a risk factor for complications in both operative and nonoperative pelvic and acetabular fractures. The authors conducted a 5-year retrospective data collection of all patients with isolated pelvic and acetabular fractures presenting to a Level I trauma center, excluding pediatric (age <18 years) patients, those with ballistic injuries, and those with concomitant long bone fractures or an Abbreviated Injury Scale score of greater than 2 in any other body region. Complications during the immediate hospitalization period were identified by the institution's Trauma Registry of the American College of Surgeons database, including wound infection, dehiscence, deep venous thrombosis, pulmonary embolus, pneumonia, and development of decubitus ulcers. Mean body mass index was 27.4 ± 6.8 kg/m(2), with 68 (27.0%) obese patients. Mean body mass index of patients with complications was significantly higher (31.9 ± 9.5 vs 27.0 ± 6.5 kg/m(2); P=.001). Logistic regression showed that obesity was a significant risk factor for complications (odds ratio, 2.87; 95% confidence interval, 1.02-8.04), after adjusting for age (odds ratio, 1.03; 95% confidence interval, 1.01-1.06) and Injury Severity Score (odds ratio, 1.20; 95% confidence interval, 1.10-1.32). Obesity is associated with increasing complications following operative fixation of pelvic and acetabular fractures. However, it is important to recognize that even nonoperative management of pelvic and acetabular fractures in obese patients can have early complications. This study showed a significant obesity-related risk of complications after trauma in both operative and nonoperative pelvic injuries.

Socioeconomic Factors Influencing Self-reported Outcomes After Posterior Wall Fractures of the Acetabulum: Lessons Learned From a Hispanic Population

“… 25 By contrast, an elevated BMI has been consistently found to negatively affect outcomes and is an independent risk factor for complications after either surgical or nonsurgical treatment. 26 Our findings are comparable with previous studies in which sex has limited influence in outcomes, but older and obese patients were more dissatisfied and reported worse functional outcomes. On the other hand, sex seems to be more consistently related to total knee arthroplasty, where women report lower satisfaction than men.…”

Obese trauma patients who sustain orthopaedic fractures experience increased length of stay, ICU admissions and mortality

“…Consistent with previous studies, obese patients who sustained fractures were found to be signifi cantly more likely to have increased hospital lengths of stay [6,7,23,[25][26][27][28], more frequent admissions to the ICU and longer associated lengths of stay in the ICU [6,13,28,29]. Furthermore, after adjusting for The authors noted that the study was underpowered to detect a statistical difference between these two groups in terms of pulmonary complications, multiple organ failure and mortality [6].…”

“…Trauma patients with higher BMIs are more likely to have increased complication rates, develop multiple system organ failure, acute respiratory distress syndrome and infections [3][4][5]. Additionally, obesity is an independent risk factor for increased morbidity and mortality following high-impact blunt force trauma and has been associated with signifi cantly longer Intensive Care Unit (ICU) lengths of stay with greater anticipated hospital costs [6,7].…”

“…There is a well-established association between increasing BMI and the probability of sustaining a musculoskeletal injury, including certain types of fractures [8]. Furthermore, several retrospective studies have identifi ed an increased risk of postoperative complications for fractures involving the ankle, tibia, femur, humerus and pelvis [7,[9][10][11][12][13][14][15]. However, the literature regarding the clinical outcomes of hospitalized obese trauma patients who sustain fractures is limited despite the increasing prevalence of obesity among this population.…”

The Effect of Abdominal Subcutaneous Fat Tissue Thickness in Pelvic Trauma

“…Thus, obesity in trauma patients is reported to lead to increased complications 18 . The incidence of pulmonary and renal complications is higher in obese patients 36 . Obese trauma patients have a greater need for mechanical ventilation and a higher incidence of multiple organ failure, and they spend a longer time in intensive care 15,18 .…”