title: Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures.
abstract: BACKGROUND
  Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database.
  
  
  METHODS
  Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90 days and mortality within 2 years postoperatively. Odds ratios and 95% confidence intervals were calculated.
  
  
  RESULTS
  From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. In each operative group, obesity was associated with a substantial increase in local and systemic complications.
  
  
  CONCLUSIONS
  Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Griffin
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brockmeier
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: fwg7d@virginia.edu.
authors.forename: F Winston
authors.initials: FW
authors.lastname: Gwathmey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D015992:Body Mass Index; D016208:Databases, Factual; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D016017:Odds Ratio; D011183:Postoperative Complications; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D014481:United States
keywords: Proximal humerus fracture; hemiarthroplasty; humeral intramedullary nail; obesity; open reduction and internal fixation; reverse total shoulder arthroplasty