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Body mass index predicts perioperative complications following orthopaedic trauma surgery: an ACS-NSQIP analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The impact of obesity on outcomes has been documented extensively in the elective orthopaedic literature, but little is known about the impact of obesity on outcomes following orthopaedic trauma surgery. Utilizing the ACS-NSQIP database, we sought to investigate the relationship between BMI and perioperative complications in orthopaedic trauma patients.

Methods

53,219 orthopaedic trauma patients were identified using a CPT code search between 2005 and 2013 in the NSQIP database. Patient demographics, and perioperative complications (including minor, major, and total) were collected. Multivariate regression analysis was performed to control for baseline demographics and comorbidities.

Results

Compared with patients of normal weight, underweight patients had significantly greater odds of minor [OR 1.12, 95 % CI (1.0, 1.26), p = 0.04], major [OR 1.20, 95 % CI (1.1, 1.3), p = 0.0009], and total complications [OR 1.18, 95 % CI (1.1, 1.3), p = 0.0003]. Morbidly obese patients had significantly greater odds of major [OR 1.22, 95 % CI (1.0, 1.5), p = 0.023] and total complications [OR 1.18, 95 % CI (1.0, 1.4), p = 0.023] compared to normal weight patients. When wound-related complications were examined independently, obesity was associated with increased odds of superficial [OR 1.67, 95 % CI (1.3, 2.1), p < 0.0001] and deep wound infection [OR 1.52, 95 % CI (1.075, 2.144), p = 0.018], and morbid obesity was associated with increased odds of wound dehiscence [OR 2.29, 95 % CI (1.1, 4.9), p = 0.034] and deep infection [OR 2.51, 95 % CI (1.6, 3.9), p < 0.0001].

Conclusions

Morbidly obese patients have significantly greater odds of wound dehiscence, deep wound infection, major complications, and total complications compared to patients of normal weight. Additionally, BMI under 18.5 is associated with increased odds of minor, major, and total perioperative complications. Interventions aimed at decreasing complication rates should be targeted at these high-risk patient populations on both ends of the BMI spectrum.

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Author information

Authors and Affiliations

  1. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA

    G. A. White-Dzuro, A. C. Dodd, N. Lakomkin, W. T. Obremskey, C. A. Collinge & M. K. Sethi

  2. Department of Orthopaedics and Rehabilitation, University of Wisconsin, 1685 Highland Ave., Madison, WI, 53705, USA

    P. S. Whiting

  3. Department of Orthopaedic Surgery, University of Cincinnati Academic Health Center, P.O. Box 670212, Cincinnati, Ohio, 45267-0212, USA

    F. R. Avilucea

Authors
  1. P. S. Whiting
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  2. G. A. White-Dzuro
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  3. F. R. Avilucea
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  4. A. C. Dodd
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  5. N. Lakomkin
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  6. W. T. Obremskey
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  7. C. A. Collinge
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  8. M. K. Sethi
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Corresponding author

Correspondence to M. K. Sethi.

Ethics declarations

Conflict of interest and source of funding

Author William T. Obremskey (WTO) has done expert testimony in legal matters. The institution of one or more authors (WTO) has received a grant from the Department of Defense. Paul S. Whiting, Gabrielle A. White-Dzuro, Frank R. Avilucea, Ashley C. Dodd, Nikita Lakomkin, Cory A. Collinge, and Manish K. Sethi declare that they have no conflict of interest.

Compliance with ethical requirements

This study was performed in accordance with the relevant regulations of the US Health Insurance Portability and Accountability Act (HIPPA) and the ethical standards of the 1964 Declaration of Helsinki. The protocol was approved by the Vanderbilt Institution Review Board.

Appendix

Appendix

See Tables 5, 6, 7, 8.

Table 5 Trauma CPT code descriptions
Full size table
Table 6 Multivariate regression for MINOR complication
Full size table
Table 7 Multivariate regression for major complications
Full size table
Table 8 Multivariate regression for total complications
Full size table

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Whiting, P.S., White-Dzuro, G.A., Avilucea, F.R. et al. Body mass index predicts perioperative complications following orthopaedic trauma surgery: an ACS-NSQIP analysis. Eur J Trauma Emerg Surg 43, 255–264 (2017). https://doi.org/10.1007/s00068-016-0642-0

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  • DOI: https://doi.org/10.1007/s00068-016-0642-0

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