title: Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower-extremity diaphyseal long-bone fractures?
abstract: Obesity is prevalent in the developed world and is associated with significant costs to the health care system. The effect of morbid obesity in patients operatively treated for long-bone fractures of the lower extremity is largely unknown. The National Trauma Data Bank was accessed to determine if morbidly obese patients (body mass index >40) with lower extremity fractures have longer length of hospital stay, higher cost, greater rehabilitation admission rates, and more complications than nonobese patients. We identified patients with operatively treated diaphyseal femur (6920) and tibia (5190) fractures. Polytrauma patients and patients younger than 16 years were excluded. Morbidly obese patients were identified by ICD-9 and database comorbidity designation (femur, 131 morbidly obese; tibia, 75 morbidly obese). Patients meeting these criteria who were not morbidly obese were used as controls. Sensitivity analyses were performed to analyze patients with isolated trauma to the tibia or femur. Morbidly obese patients were more likely to be admitted to a subacute facility. Length of stay trended higher in morbidly obese patients. There was no significant relationship between obesity and inpatient mortality or inpatient complications. These trends held true when considering patients with multiple injuries and patients who had isolated long-bone injuries. Our study showed that morbidly obese patients may have greater rehabilitation needs following long-bone fractures in the lower extremity. Our study showed no difference in mortality or complications, although further studies are needed to confirm these findings.
authors.affiliation: Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
authors.forename: Paul E
authors.initials: PE
authors.lastname: Matuszewski
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
authors.forename: John L
authors.initials: JL
authors.lastname: Esterhai
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
mesh_terms: D000328:Adult; D017281:Cost of Illness; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000534:rehabilitation*; D005596:Fractures, Closed / Q000401:mortality / Q000534:rehabilitation*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000401:mortality; D011183:Postoperative Complications; D012307:Risk Factors; D015996:Survival Rate; D013978:Tibial Fractures / Q000401:mortality / Q000534:rehabilitation*; D014481:United States / Q000453:epidemiology