The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures

Abstract

<jats:p>Background: Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. Methods: In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient’s ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO’s BMI groups. Results: The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 ± 4.8 days), normal (13.6 ± 7.8 days), overweight (14.2 ± 11.7 days), and obese patients (16.0 ± 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 ± 42.9 min; normal weight = 90.2 ± 38.2 min; overweight = 99.9 ± 39.9 min; obese = 117.2 ± 61.5 min (p &lt; 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5–30 kg/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient’s ability to walk on crutches. Conclusion: Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function.</jats:p>

Inverse relation of body weight with short-term and long-term mortality following hip fracture surgery: a meta-analysis

“…Five studies were meta-analyzed for the risk of short-term (≤ 30-day) mortality after hip fracture surgery [ 18 , 23 – 26 ]. The OR was 0.63 (95% CI: 0.58–0.68; P < 0.00001) for short-term mortality in the group with obesity compared with the average-weight group (Fig.…”

Functional Application of Tricks for Super Obese Patient Positioning: A Technical Guide for Hip Fractures on a Fracture Table With a Case Example

“…As obesity becomes a more common diagnosis within the hip fracture patient population, it becomes necessary to develop a standardized intraoperative approach to positioning to care for this specific patient population to avoid the known increased risk of complications [14][15][16][17]. A recent study by Bekeris et al reported an increased incidence of comorbidities, including obesity amongst hip fracture patients, and Sems et al reported increased complication rates following surgical fixation of pelvic ring injuries in obese patients [14,15].…”

“…A recent study by Bekeris et al reported an increased incidence of comorbidities, including obesity amongst hip fracture patients, and Sems et al reported increased complication rates following surgical fixation of pelvic ring injuries in obese patients [14,15]. Furthermore, a study of 950 patients by Muller et al reported that increased BMI in patients with hip fractures is associated with both longer operation time and length of hospitalization [16].…”

“…A recent study by Bekeris et al reported an increased incidence of comorbidities, including obesity amongst hip fracture patients, and Sems et al reported increased complication rates following surgical fixation of pelvic ring injuries in obese patients [ 14 , 15 ]. Furthermore, a study of 950 patients by Muller et al reported that increased BMI in patients with hip fractures is associated with both longer operation time and length of hospitalization [ 16 ]. Specifically, intertrochanteric hip fracture patients with a BMI greater than 30kg/m 2 are more likely to sustain systemic complications, including respiratory complications, electrolyte abnormalities, and sepsis [ 18 ].…”

Management of femoral shaft infected nonunion through customised Ilizarov external fixator assembly in a morbidly obese patient

“…Starting from the initial radiological evaluation in lieu of the thickened soft tissues, especially around the proximal femur to the follow-up, the care of obese patients must be optimised in a multidisciplinary manner 3. The most common problems and complications reported in obese patients suffering from femur fracture are prolonged operative duration, longer length of stay in hospital, wound infections, revision surgeries and some systemic complications 4–6. Furthermore, special surgical equipment, including larger and stronger tables, special supports, as well as specially designed instruments, are usually required 1.…”