title: Obesity is associated with increased postoperative complications after operative management of tibial shaft fractures.
abstract: OBJECTIVE
  To assess the association of obesity and postoperative complications after operative management of tibial shaft fractures.
  
  
  METHODS
  Patients who underwent operative management of a tibial shaft fracture were identified in a national database by Current Procedural Terminology (CPT) codes for: (1) open reduction and internal fixation (ORIF) and (2) intramedullary nailing (IMN) procedures in the setting of International Classification of Diseases, Ninth Revision (ICD-9) codes for tibial shaft fracture. These groups were then divided into non-obese, obese, and morbidly obese cohorts using ICD-9 codes. Each cohort was then assessed for grouped complications within 90 days, removal of implants within 6 months, and nonunion within 9 months postoperatively. Odds ratios and 95% confidence intervals were calculated.
  
  
  RESULTS
  From 2005 to 2012, 14,638 patients who underwent operative management of tibial shaft fractures were identified, including 4425 (30.2%) ORIF and 10,213 (69.8%) IMN. Overall, 1091 patients (7.4%) were coded as obese and 820 (5.6%) morbidly obese. In each operative group, obesity and morbid obesity was associated with a substantial increase in the rate of major and minor medical complications, venous thromboembolism, infection, procedures for implant removal, and nonunion.
  
  
  CONCLUSIONS
  In patients who undergo either ORIF or IMN for tibial shaft fractures, obesity and its related medical comorbidities are associated with significantly increased rates of postoperative medical complications, infection, nonunion, and implant removal compared to non-obese patients.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, United States.
authors.forename: M Tyrrell
authors.initials: MT
authors.lastname: Burrus
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, United States.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Division of Orthopaedic Trauma, University of Virginia Health System, PO Box 800159 HSC, Charlottesville, VA, 22908, United States. Electronic address: SRY2J@virginia.edu.
authors.forename: Seth R
authors.initials: SR
authors.lastname: Yarboro
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000601:surgery; D016017:Odds Ratio; D010353:Patient Education as Topic; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011300:Preoperative Care; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology*; D013978:Tibial Fractures / Q000601:surgery*; D014481:United States / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology*
keywords: Complication; Infection; Medical; Nonunion; Obesity; Tibia fracture