The Association between High Body Mass Index and Early Clinical Outcomes in Patients with Proximal Femur Fractures
| Autor: | Lisa Völker, Alexander Gutwerk, Michael Zyskowski, Karl Friedrich Braun, Frederik Greve, Chlodwig Kirchhoff, Michael Muller, Peter Biberthaler, Dominik Pförringer |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
obesity complications medicine.medical_treatment Population lcsh:Medicine body mass index proximal femoral fracture Overweight Femoral Neck Fractures Article 03 medical and health sciences BMI 0302 clinical medicine medicine 030212 general & internal medicine education Femoral neck 030222 orthopedics education.field_of_study Hip fracture business.industry lcsh:R General Medicine medicine.disease Arthroplasty Surgery ddc functional outcomes medicine.anatomical_structure hip fracture arthroplasty Underweight medicine.symptom business Body mass index |
| Zdroj: | Journal of Clinical Medicine Volume 9 Issue 7 Journal of Clinical Medicine, Vol 9, Iss 2076, p 2076 (2020) |
| Popis: | Background: Fractures of the proximal femur constitute daily work in orthopedic trauma surgery. With the continuous increase of obesity in the general population, surgeons face several known technical challenges. The aim of this study was to investigate the association of high body mass index (BMI) in patients with proximal femur fractures with intra- and postoperative adverse events, as well as with functional outcomes after successful surgery. Methods: In this retrospective, single-center cohort study, 950 patients who sustained a fracture of the proximal femur (femoral neck fracture or trochanteric fracture) and underwent surgical treatment at our level I trauma center between 2003 and 2015 were included. Patient-specific data were obtained in regard to demographics, comorbidities, and fracture morphology. In-hospital postoperative complications (i.e., need for revision surgery, wound site infection, pneumonia, urinary tract infection, necessary transfusion, and deep-vein thrombosis) were analyzed, along with the length of hospitalization and overall mortality rate. Functional outcome was assessed using the Barthel index and the patient&rsquo s ability to walk on crutches. Mortality rate and need for revision surgery were assessed over a two-year time period. Any adverse event was correlated to one of the four WHO&rsquo s BMI groups. Results: The cohort included 80 (8.4%) underweight patients, 570 (60.0%) normal weight patients, 241 (25.4%) overweight patients, and 59 (6.2%) obese patients. We found more femoral neck fractures (506, or 53%) than trochanteric fractures (444, or 47%). In bivariate analysis, no significant difference was found in regard to overall mortality or postoperative complications. Hospitalization time (LOS) differed between the underweight (12.3 ± 4.8 days), normal (13.6 ± 7.8 days), overweight (14.2 ± 11.7 days), and obese patients (16.0 ± 9.7 days) (p = 0.040). Operation time increased stepwise with increasing BMI: underweight = 85.3 ± 42.9 min normal weight = 90.2 ± 38.2 min overweight = 99.9 ± 39.9 min obese = 117.2 ± 61.5 min (p < 0.001). No significant difference was found by analyzing functional outcomes. However, patients with intermediate BMI levels (18.5&ndash 30 kg/m2) tended to achieve the best results, as represented by a higher Barthel index score and the patient&rsquo s ability to walk on crutches. Conclusion: Increased BMI in patients with proximal femur fractures is associated with both longer operation time and length of hospitalization (LOS). Postoperative mobilization and functional outcomes appear to follow a reversed J-curve distribution (with overweight patients showing the best functional results), whereas both obese and underweight patients have associated poorer function. |
| Databáze: | OpenAIRE |
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