Studies have shown that the prevalence of obesity in the United States has increased substantially over the past 2 decades.

Obesity is associated with many other disease processes and comorbidities that can complicate medical care.

“As the prevalence of obesity has risen, so too has the number of obese orthopedic trauma patients,” says Heather Licht, MD. “These patients bring with them a large array of complexities, including more comorbidities and differences in injury patterns. If surgery is required, obesity can make it technically more difficult to perform.”

Taking a Closer Look

For a study published in the Journal of Bone & Joint Surgery, Dr. Licht and colleagues used CT-based measures of adiposity to calculate a “truncal BMI” in order to determine the effect of obesity on hospital charges, lengths of stay, and the need for orthopaedic surgery. The analysis also examined if obesity correlated with a worse discharge disposition for patients with orthopaedic trauma.

The investigators identified 301 patients with orthopaedic injuries at a level I trauma center from 2006 to 2011. Patients with a truncal BMI of less than 30 kg/m2 were categorized as non-obese whereas those with higher BMIs were deemed obese. Patients with obesity were then further divided into Class I obesity—in which BMIs ranged between 30 kg/m2 and 35 kg/m2—or Class II obesity—in which BMIs were higher than 35 kg/m2.

According to the results, patients who were obese had a higher need for surgery when presenting with orthopaedic trauma (72% vs 55%). The degree of obesity also had an impact on need for surgery. About two-thirds of Class I patients had surgery, but this rate escalated to higher than 93% for patients classified as Class II.

Study participants with normal BMIs also had shorter hospital stays and lower average hospital costs than those with BMI levels of 30 kg/m2 or higher. A greater proportion of Class II patients required discharge to a continuing care facility. “Our study also showed that even when patients had the same severity of injuries, resource utilization was higher among patients with obesity when compared with non-obese individuals,” Dr. Licht says.

Examining Implications

Dr. Licht is hopeful that the study information will help improve prevention measures and lead to more aggressive care so that outcomes in obese patients can be optimized. “In addition,” she says, “this data may be used in the future to improve reimbursement for the increased care requirements among obese patients.”

In light of the findings, physicians should inform obese patients that they are likely to have higher total hospital charges and longer ICU and hospital stays after experiencing an orthopaedic trauma. Dr. Licht adds that more research is needed to determine why obese patients are more likely to require surgical interventions. “More studies are also warranted to find variables that may further optimize care for this patient population,” says Dr. Licht.

References

Licht H, Murray M, Vassaur J, et al. The relationship of obesity to increasing healthcare burden in the setting of orthopaedic polytrauma. J Bone Joint Surg Am. 2015;97: e73. Available at: http://jbjs.org/content/97/22/e73.

Maheshwari R, Mack CD, Kaufman RP, et al. Severity of injury and outcomes among obese trauma patients with fractures of the femur and tibia: a crash injury research and engineering network study. J Orthop Trauma. 2009;23:634-639.

Evans DC, Stawicki SP, Davido HT, Eiferman D. Obesity in trauma patients: correlations of body mass index with outcomes, injury patterns, and complications. Am Surg. 2011;77:1003-1008.

Baldwin KD, Matuszewski PE, Namdari S, Esterhai JL, Mehta S. Does morbid obesity negatively affect the hospital course of patients undergoing treatment of closed, lower extremity diaphyseal long-bone fractures? Orthopedics. 2011;34:18.