The Impact of Obesity on Complications of Elbow, Forearm, and Hand Surgeries

Abstract

Purpose: To compare the rates of postoperative complications in obese and non-obese patients following elbow, forearm, and hand surgeries. Methods: This case-control study examined 436 patients whose body mass index (BMI) was over 35 and who underwent hand, wrist, forearm, or elbow surgery between 2009-2013. Controls were patients (n=433) with a BMI<30 who had similar surgeries over the same period, and frequency-matched by type of surgery (i.e., bony, soft tissue, or nerve), age, and sex. Postoperative complications were defined as infection requiring antibiotic or reoperation, delayed incision healing, nerve dysfunction, wound dehiscence, hematoma, and other reoperation. Medical comorbidities (e.g., hypertension, diabetes, stroke, vascular disease, kidney disease, and liver disease) were recorded. Chi-square analyses were performed to explore the association between obesity and postoperative complications. Similar analyses were performed stratified by surgery type and BMI classification. Logistic regression modeling was performed to identify predictors of postoperative complications accounting for surgery type, BMI, the presence of comorbidities, patient age, and patient sex. This same model was also run separately for case and control patients. Results: The overall complication rate was 8.7% with similar rates between obese and non-obese patients (8.5% vs 9.0%). Bony procedures resulted in the greatest risk of complication in both groups (15% each group). Multivariate analysis confirmed surgery type as the only significant predictor of complications for non-obese patients. However, among obese patients, both bony surgery and increasing BMI were associated with greater complication rates. Discussion: Not all obese patients appear to be at any higher risk for complications after elbow, forearm, and hand surgery compared to non-obese patients. However, there appears to be a dose-dependent effect of BMI among obese patients such that increasing-obesity heightens the risk of complications, especially for those with a BMI greater than 45. Level of Evidence: Prognostic, Level II

Obesity is Not Associated with Increased Short-term Complications After Primary Total Shoulder Arthroplasty

“…Investigations regarding the effects and outcomes of lower extremity arthroplasty have shown a greater proportion of complications in patients who are obese compared with those who are not obese [16,17]. However, the association of BMI and higher complications in lower extremity surgery cannot be directly correlated to the surgeries performed in the upper extremity [25]. Thus, the large sample size and Totally dependent national representation of this study provide additional evidence to suggest that increased BMI is not associated with increased short-term complications in patients undergoing primary TSA.…”

“…Linberg et al [24] reported that patients who are morbidly obese have a greater incidence of unsatisfactory results after TSA. However, a review of upper extremity surgery concluded that patients who are obese are not at increased risk of complications compared with patients who are not obese [25]. Singh et al [28] reported that higher BMI was actually protective against postoperative mortality after primary shoulder arthroplasty.…”

Initial diagnostic management of pediatric bone tumors

“…Recently, Novais and colleagues demonstrated obesity to be a major risk factor for developing complications after osteotomy [38], while others have similarly focused on other orthopedic procedures [39-41]. Moore et al also reported obesity to be an independent risk factor for major wound complications after soft tissue sarcoma resection [42].…”

Being overweight has limited effect on SCARF osteotomy outcome for hallux valgus correction

“…London et al compared the rates of post-operative complications in obese and nonobese patients following elbow, forearm and hand surgery [5]. According to their results, increasing BMI in the obese group was associated with greater complication rates compared with the group with BMI within the normal range.…”