title: Obesity is associated with increased postoperative complications after operative management of distal humerus fractures.
abstract: BACKGROUND
  Distal humerus fractures commonly require surgical intervention, including open reduction and internal fixation (ORIF) and, more recently in elderly, low-demand individuals, total elbow arthroplasty (TEA). The association of obesity with complications after either of these procedures has not previously been examined.
  
  
  METHODS
  A national insurance database was queried for ORIF or TEA for management of a distal humerus fracture using procedural and diagnostic codes. Patients in each operative group were then divided into nonobese and obese cohorts. These cohorts were then queried for postoperative complications within 90 days after the surgical procedure using diagnostic and procedural codes. χ(2) tests were calculated to determine statistical significance, with P < .05 considered significant.
  
  
  RESULTS
  A total of 6928 patients who underwent operative management of a distal humerus fracture were identified, including 4215 ORIF and 2713 TEA procedures. The obese ORIF patients had a significantly increased risk of 90-day local (odds ratio [OR], 2.5; P < .0001) and systemic (OR, 5.9; P < .0001) complications. The rates of postoperative infection, venous thromboembolism, and medical complications were significantly higher in the obese ORIF cohort than in nonobese patients. The obese TEA patients had a significantly increased risk of 90-day local (OR, 2.6; P < .0001) and systemic (OR, 4.4; P < .0001) complications. The rates of postoperative infection, venous thromboembolism, and medical complications were higher in the obese TEA cohort than in nonobese patients.
  
  
  CONCLUSIONS
  Obesity is associated with significantly higher rates of complications after ORIF and TEA for distal humerus fractures than in nonobese patients.
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: Robert B
authors.initials: RB
authors.lastname: Rawles
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: J Taylor
authors.initials: JT
authors.lastname: Jobe
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA.
authors.forename: A Bobby
authors.initials: AB
authors.lastname: Chhabra
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA. Electronic address: amf7z@hscmail.mcc.virginia.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Freilich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology
keywords: Obesity; complications; distal humerus fractures; open reduction and internal fixation; total elbow arthroplasty