title: Obesity Is Associated With More Complications and Longer Hospital Stays After Orthopaedic Trauma.
abstract: OBJECTIVE
  The objective of this study was to characterize relationships between obesity and initial hospital stay, including complications, in patients with multiple system trauma and surgically treated fractures.
  
  
  METHODS
  Prospective, observational.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  Three hundred seventy-six patients with an Injury Severity Score greater than 16 and mechanically unstable high-energy fractures of the femur, pelvic ring, acetabulum, or spine requiring stabilization.
  
  
  METHODS
  Data for obese (body mass index ≥ 30) versus nonobese patients included presence of pneumonia, deep vein thrombosis, pulmonary embolism, infection, organ failure, and mortality. Days in ICU and hospital, days on ventilator, transfusions, and surgical details were documented.
  
  
  RESULTS
  Complications occurred more often in obese patients (38.0% vs. 28.4%, P = 0.03), with more acute renal failure (5.70% vs. 1.38%, P = 0.02) and infection (11.4% vs. 5.50%, P = 0.04). Days in ICU and mechanical ventilation times were longer for obese patients (7.06 vs. 5.25 days, P = 0.05 and 4.92 vs. 2.90 days, P = 0.007, respectively). Mean total hospital stay was also longer for obese patients (12.3 vs. 9.79 days, P = 0.009). No significant differences in rates of mortality, multiple organ failure, or pulmonary complications were noted. Medically stable obese patients were almost twice as likely to experience delayed fracture fixation due to preference of the surgeon and were more likely to experience delay overall (26.0% vs. 16.1%; P = 0.02). Mean time from injury to fixation was 34.9 hours in obese patients versus 23.7 hours in nonobese patients (P = 0.03).
  
  
  CONCLUSIONS
  Obesity was noted among 42% of our trauma patients. In obese patients, complications occurred more often and hospital and ICU stays were significantly longer. These increases are likely to be associated with greater hospital costs. Surgeon decision to delay procedures in medically stable obese patients may have contributed to these findings; definitive fixation was more likely to be delayed in obese patients. Further study to optimize the care of patients with increased body mass index may help to improve outcomes and minimize additional treatment expenses.
authors.affiliation: *Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Childs
authors.forename: Nickolas J
authors.initials: NJ
authors.lastname: Nahm
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Dolenc
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D009765:Obesity / Q000191:economics / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies