Effects of Obesity on Systemic Complications After Operative Pelvic Ring Fractures.

ABSTRACT

OBJECTIVES: To determine the effect of obesity on systemic complications after operative pelvic ring injuries. DESIGN: Retrospective cohort study. SETTING: Single level 1 trauma center. PATIENT SELECTION CRITERIA All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015 to 2022 were included. Patients were grouped based on body mass index (BMI) into 4 categories (normal = BMI <25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI >40). OUTCOME MEASURES AND COMPARISONS Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared with those who did not regarding demographic and clinical parameters to determine risk factors for each complication. RESULTS: A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI was also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40). CONCLUSIONS: This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication, specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain postoperative complications during the initial trauma admission. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.