Complications and 30-Day Mortality Rate After Hip Fracture Surgery in Superobese Patients.
Journal
Journal of orthopaedic trauma
ISSN: 1531-2291
Titre abrégé: J Orthop Trauma
Pays: United States
ID NLM: 8807705
Informations de publication
Date de publication:
01 06 2021
01 06 2021
Historique:
accepted:
13
10
2020
pubmed:
10
11
2020
medline:
22
6
2021
entrez:
9
11
2020
Statut:
ppublish
Résumé
Paradoxically, overweight and obesity are associated with lower odds of complications and death after hip fracture surgery. Our objective was to determine whether this "obesity paradox" extends to patients with "superobesity." In this study, we compared rates of complications and death among superobese patients with those of patients in other body mass index (BMI) categories. Using the National Surgical Quality Improvement Program database, we identified >100,000 hip fracture surgeries performed from 2012 to 2018. Patients were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-39.9), morbidly obese (BMI 40-49.9), or superobese (BMI ≥50). We analyzed patient characteristics, surgical characteristics, and 30-day outcomes. Using multivariate regression with normal-weight patients as the referent, we determined odds of major complications, minor complications, and death within 30 days by BMI category. Of 440 superobese patients, 20% had major complications, 33% had minor complications, and 5.2% died within 30 days after surgery. When comparing patients in other BMI categories with normal-weight patients, superobese patients had the highest odds of major complications [odds ratio (OR): 1.6, 95% confidence interval (CI), 1.2-2.0] but did not have significantly different odds of death (OR: 0.91, 95% CI, 0.59-1.4) or minor complications (OR: 1.2, 95% CI, 0.94-1.4). Superobese patients had significantly higher odds of major complications within 30 days after hip fracture surgery compared with all other patients. This "obesity paradox" did not apply to superobese patients. Prognostic Level III. See Instructions for Authors for a Complete Description of Levels of Evidence.
Identifiants
pubmed: 33165206
pii: 00005131-202106000-00007
doi: 10.1097/BOT.0000000000001987
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
322-328Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflict of interest.
Références
Wang Y, Beydoun MA, Min J, et al. Has the prevalence of overweight, obesity and central obesity levelled off in the United States? Trends, patterns, disparities, and future projections for the obesity epidemic. Int J Epidemiol. 2020;49:810–823.
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes. 2013;37:889–891.
Ponnusamy KE, Somerville L, McCalden RW, et al. Revision rates and functional outcome scores for severely, morbidly, and super-obese patients undergoing primary total hip arthroplasty: a systematic review and meta-analysis. JBJS Rev. 2019;7:e11.
Rajgopal R, Martin R, Howard JL, et al. Outcomes and complications of total hip replacement in super-obese patients. Bone Joint J. 2013;95-B:758–763.
Werner BC, Evans CL, Carothers JT, et al. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty. 2015;30:849–853.
Gupta M, Dugan A, Chcon E, et al. Detailed Perioperative Risk Among Patients with Extree Obesity Undergoing Nonbariatric General Surgery. Surgery. 2020;168:462–470.
Tyson GH III, Rodriguez E, Elci OC, et al. Cardiac procedures in patients with a body mass index exceeding 45: outcomes and long-term results. Ann Thorac Surg. 2007;84:3–9; discussion 9.
Anderson LA, Goodman RA, Holtzman D, et al. Aging in the United States: opportunities and challenges for public health. Am J Public Health. 2012;102:393–395.
Sayed-Noor AS, Mukka S, Mohaddes M, et al. Body mass index is associated with risk of reoperation and revision after primary total hip arthroplasty: a study of the Swedish hip arthroplasty register including 83,146 patients. Acta Orthop. 2019;90:220–225.
Turrentine FE, Hanks JB, Schirmer BD, et al. The relationship between body mass index and 30-day mortality risk, by principal surgical procedure. Arch Surg. 2012;147:236–242.
Hartrumpf M, Kuehnel RU, Albes JM. The obesity paradox is still there: a risk analysis of over 15,000 cardiosurgical patients based on body mass index. Interact Cardiovasc Thorac Surg. 2017;25:18–24.
Mullen JT, Moorman DW, Davenport DL. The obesity paradox: body mass index and outcomes in patients undergoing nonbariatric general surgery. Ann Surg. 2009;250:166–172.
Modig K, Erdefelt A, Mellner C, et al. Obesity paradox holds true for patients with hip fracture: a registry-based cohort study. J Bone Joint Surg Am. 2019;101:888–895.
Akinleye SD, Garofolo G, Culbertson MD, et al. The role of BMI in hip fracture surgery. Geriatr Orthop Surg Rehabil. 2018;9:2151458517747414.
Henderson WG, Daley J. Design and statistical methodology of the national surgical quality improvement program: why is it what it is? Am J Surg. 2009;198:S19–S27.
Sathiyakumar V, Greenberg SE, Molina CS, et al. Hip fractures are risky business: an analysis of the NSQIP data. Injury. 2015;46:703–708.
Skube SJ, Lindemann EA, Arsoniadis EG, et al. Characterizing functional health status of surgical patients in clinical notes. AMIA Joint Summits Transl Sci Proc. 2018;2017:379–388.
National Heart L, Blood Institute. Calculate your body mass index. Available at www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi-m.htm . Accessed April 7, 2020.
Bohl DD, Basques BA, Golinvaux NS, et al. Extramedullary compared with intramedullary implants for intertrochanteric hip fractures: 30-days outcomes of 4432 procedures from the ACS NSQIP database. J Bone Joint Surg Am. 2014;96:1871–1877.
Golinvaux NS, Bohl DD, Basques BA, et al. Diabetes confers little to no increased risk of postoperative complications after hip fracture surgery in geriatric patients. Clin Orthop Relat Res. 2015;473:1043–1051.
Bohl DD, Fu MC, Gruskay JA, et al. July effect in elective spine surgery: analysis of the American College of Surgeons National Surgical Quality Improvement Program database. Spine. 2014;39:603–611.
D'Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49:1429–1433.
Molina CS, Thakore RV, Blumer A, et al. Use of the National Surgical Quality Improvement Program in orthopaedic surgery. Clin Orthop Relat Res. 2015;473:1574–1581.
Suskind AM, Walter LC, Jin C, et al. Impact of frailty on complications in patients undergoing common urological procedures: a study from the American College of Surgeons National Surgical Quality Improvement database. BJU Int. 2016;117:836–842.
Xu BY, Yan S, Low LL, et al. Predictors of poor functional outcomes and mortality in patients with hip fracture: a systematic review. BMC Musculoskelet Disord. 2019;20:568.
Seitz DP, Anderson GM, Austin PC, et al. Effects of impairment in activities of daily living on predicting mortality following hip fracture surgery in studies using administrative healthcare databases. BMC Geriatr. 2014;14:9.
Prieto-Alhambra D, Premaor MO, Aviles FF, et al. Relationship between mortality and BMI after fracture: a population-based study of men and women aged >/=40 years. J Bone Miner Res. 2014;29:1737–1744.
World Health Organization. Nutrition landscape information system (NLiS): help topic: malnutrition in women. Available at: https://pubmed.ncbi.nlm.nih.gov/27642056/ . Accessed April 30, 2020.
Aldebeyan S, Nooh A, Aoude A, et al. Hypoalbuminaemia-a marker of malnutrition and predictor of postoperative complications and mortality after hip fractures. Injury. 2017;48:436–440.
Traven SA, Reeves RA, Althoff AD, et al. New five-factor modified frailty index predicts morbidity and mortality in geriatric hip fractures. J Orthop Trauma. 2019;33:319–323.
Werner BC, Higgins MD, Pehlivan HC, et al. Super obesity is an independent risk factor for complications after primary total hip arthroplasty. J Arthroplasty. 2017;32:402–406.
Valentijn TM, Galal W, Tjeertes EK, et al. The obesity paradox in the surgical population. Surgeon. 2013;11:169–176.
Lee DH, Keum N, Hu FB, et al. Predicted lean body mass, fat mass, and all cause and cause specific mortality in men: prospective US cohort study. BMJ. 2018;362:k2575.
Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3:280–287.
Arshi A, Rezzadeh K, Stavrakis AI, et al. Standardized hospital-based care programs improve geriatric hip fracture outcomes: an analysis of the ACS NSQIP targeted hip fracture series. J Orthop Trauma. 2019;33:e223–e228.
McNelis J, Castaldi M. The National Surgery Quality Improvement Project (NSQIP): a new tool to increase patient safety and cost efficiency in a surgical intensive care unit. Patient Saf Surg. 2014;8:19.
Sheils CR, Dahlke AR, Kreutzer L, et al. Evaluation of hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. Surgery. 2016;160:1182–1188.