title: The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.
abstract: BACKGROUND
  With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma.
  
  
  METHODS
  A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of <30 kg/m(2) denoted non-obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups.
  
  
  RESULTS
  Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p < 0.0002), higher rate of orthopaedic surgical intervention (p < 0.01), and increased total hospital charges (p < 0.001).
  
  
  CONCLUSIONS
  Computed tomographic scans, routinely obtained at the time of admission, can be utilized to calculate truncal adiposity and to investigate the impact of obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention.
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: Heather
authors.initials: H
authors.lastname: Licht
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: Mark
authors.initials: M
authors.lastname: Murray
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: John
authors.initials: J
authors.lastname: Vassaur
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Jupiter
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Regner
authors.affiliation: Baylor, Scott & White Health, 2401 South 31st Street, Temple, TX 76508. E-mail address for H. Licht: HLICHT@sw.org.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Chaput
mesh_terms: D050154:Adiposity; D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D021621:Imaging, Three-Dimensional; D004204:Joint Dislocations / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008022:Ligaments / Q000293:injuries*; D008134:Long-Term Care / Q000706:statistics & numerical data; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging / Q000191:economics; D019637:Orthopedic Procedures / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000191:economics / Q000706:statistics & numerical data; D014481:United States