N. N. Branch1, R. Wilson1 1Howard University College Of Medicine,Washington, DC, USA
Introduction: Obesity is known to be associated with postoperative complications. Few articles investigate the association between obesity and isolated open tibia fractures {IOTF), thus understanding how this condition will affect patient outcomes is critical. We aim to determine perioperative complications after open reduction and internal fixation (ORIF) of IOTF in morbidly obese (MO) patients using a large national sample.
Methods: Using ICD-9 codes we reviewed the National Trauma Data Bank (NTDB) from 2007- 2010. Patients 18 years and older with open IOTF who underwent ORIF at level I or II trauma centers were identified. Multivariate logistic regression and univariate analyses were used to investigate postoperative complications. The NTDB defines obesity as a body mass index (BMI) of 40 or greater, which for the purposes of this study is reference as morbid obesity.
Results: 7,201 cases met inclusion criteria. The majority were white males ages 25-44 with private insurance injured in motor vehicle collisions. 248 (3.44%) of those patients were MO. On multivariate analysis morbidly obese patients had a 40% increased odds (OR: 1.41 CI: 1.07-1.84 p=0.014) of undergoing ORIF after hospital day 2 and were two times more likely to develop acute respiratory distress syndrome (OR: 2.0 Cl: 1.08-3.71 p=0.028). MO patients were more likely to develop superficial (OR: 3.19 Cl: 1.17-8.74 p=0.024), organ/space (OR: 1.75 Cl: 1.08-2.85 p=0.024), or any surgical site infection (OR: 1.93 Cl: 1.23-3.03 p=0.004). MO patients were two times more likely to have at least one complication (OR: 2.01 Cl: 1.35-2.99 p=0.001), and more than four times more likely to develop cardiac arrest (OR: 4.28 Cl: 1.31-13.71 p=0.014). Mortality and length of stay were not associated with being MO (Table 1).
Conclusion: Morbid obesity was found to be associated with increased perioperative complications in IOTF. These patients are at greater risk of infectious complications, most notably superficial surgical site infections. Delays in time to surgical fixation may be secondary to concurrent trauma related injuries while optimizing the patient for surgery. Despite having a significantly higher risk of cardiopulmonary complications, morbidly obese patients did not have an increased mortality.
