The Effect of Obesity on Operative Time and Postoperative Complications for Peritrochanteric Femur Fractures

Abstract

Introduction The high prevalence of obesity among adults in the United States presents significant challenges to orthopedic surgeons. Obesity has been shown to increase operative time and complications in both elective and nonelective orthopedic surgeries. Despite this, there is a lack of literature evaluating the effect obesity has on operative time and postoperative complications following peritrochanteric fracture surgery. Methods and Materials We performed a retrospective review of patients who underwent isolated operative stabilization of a peritrochanteric femur fracture at our urban level one trauma center between 2010 and 2018. Patients were divided into an obese group, as defined by a body mass index (BMI) equal to or greater than 30 kg/m 2 , and a nonobese group, as defined by a BMI less than 30 kg/m 2. Operative timing variables including time to surgery, operative time, total operating room (OR) time, anesthesia time, and fluoroscopy time were collected. Postoperative variables evaluated including the presence of a major postoperative complication within 90 days of surgery, the need for repeat surgery within 90 days, and the need for surgery due to an infection within 90 days were collected. Results A total of 175 patients were included in this retrospective review. Thirty-seven patients were included in the obese group, and 138 were included in the nonobese group. Obesity was associated with a significantly (p = 0.002) longer operative time, total OR time (p = 0.0001), anesthesia time (p = 0.00006), and fluoroscopy time (p = 0.0001). There was no significant difference (p > 0.05) in postoperative variables between the obese and nonobese group. The 90-day major postoperative complication rate was 10.8% in the obese group and 10.9% in the nonobese group. Both repeat surgery and surgery for infection within 90 days were 2.7% in the obese group and 1.4% in the nonobese group. Conclusion The treatment of peritrochanteric femur fractures in obese patients is associated with a significantly longer operative time, total OR time, anesthesia time, and fluoroscopy time, but no difference in major postoperative complications when compared to nonobese patients.

Impact of obesity on outcomes after surgical stabilization of multiple rib fractures: Evidence from the US nationwide inpatient sample

“…However, a contrasting perspective study from a femur fracture fixation study where, despite the association of obesity with prolonged operative durations, postoperative complications between obese and non-obese patients did not differ significantly. This included repeat surgeries and surgeries for infection up to 90 days postoperatively [ 3 ]. Those authors postulated that patient positioning, intraoperative imaging, and difficulties in fracture reduction demanded added surgical effort and time, contributing directly to the longer duration of surgery.…”

“…Since mortality rates are low in the setting of rib fracture surgeries, our present study examined only in-patient outcomes and did not address possible benefits associated with a higher BMI status. Meanwhile, other studies report that hip fracture surgeries in obese patients take significantly longer operative time and demand more work from surgeons compared to their non-obese counterparts [ 3 ], which ultimately leads to increased LOS and higher medical bills. In fact, among the various patient-related factors affecting surgical durations, a BMI exceeding 30 stands out as the most influential [ 4 ].…”

Effects of increased body mass index on one year outcomes following soft tissue arthroscopic shoulder instability repair

“…In our study, we found obesity to be associated with an increased mean operative time, a finding consistent with that of other orthopedic procedures including reverse TSA, peritrochanteric femur fractures, anterior cruciate ligament reconstructions, and distal radius fractures. 12 , 18 , 28 , 32 , 37 , 44 Compared to those with a normal BMI, obese patients required 132% more time to complete surgery. This may be indicative of difficulty with positioning obese patients, creating portals, as well as the potential need for special instruments.…”

Obesity negatively affects outcomes following arthroscopic rotator cuff repair at four-year follow-up

“…Other orthopaedic realms such as arthroplasty, trauma, and spine have similarly seen prolonged operative times in this specific population. [21][22][23] In shoulder arthroscopy excess extremity fat theoretically complicates the surgery by limiting the identification of surface landmarks and causing soft tissue constraints leading to difficult maneuverability while facilitating the repair. Ultimately, this extended operative time prompts more resources, cost, and effort necessary to accomplish the same task.…”