Abstract
Aims: The aim of this systemic review is to identify the complications that arise in operating on orthopaedic trauma patients with an abnormal body mass index (BMI). Materials and Methods: Systematic literature search using a combination of MESH subject headings and free text searching of Medline, Embase, SCOPUS and Cochrane databases in August 2019. Any orthopaedic injury requiring surgery was included. Papers were reviewed and quality assessed by two independent reviewers to select for inclusion. Where sufficiently homogenous, meta-analysis was performed. Results: A total of 26 articles (379,333 patients) were selected for inclusion. All complications were more common in those with a high BMI (>30). The odds ratio (OR) for high BMI patients sustaining post-operative complication of any type was 2.32 with a 23% overall complication rate in the BMI > 30 group, vs. 14% in the normal BMI group (p < 0.05). The OR for mortality was 3.5. The OR for infection was 2.28. The OR for non-union in tibial fractures was 2.57. Thrombotic events were also more likely in the obese group. Low BMI (<18.5) was associated with a higher risk of cardiac complications than either those with a normal or high BMI (OR 1.56). Conclusion: Almost all complications are more common in trauma patients with a raised BMI. This should be made clear during the consent process, and strategies developed to reduce these risks where possible. Unlike in elective surgery, BMI is a non-modifiable risk factor in the trauma context, but an awareness of the complications should inform clinicians and patients alike. Underweight patients have a higher risk of developing cardiac complications than either high or normal BMI patient groups, but as few studies exist, further research into this group is recommended.
Highlights
The impact of obesity and increased body mass index (BMI) upon health services is a growing concern both nationally and internationally [1]
This review indicates that compared to patients with a normal BMI, obese orthopaedic trauma patients face greater risk of overall complications, including mortality, wound problems, cardiac events and thrombotic events
As a high BMI increases the risk of complications related to post orthopaedic trauma surgery, consideration of this should be at the forefront when faced with obese trauma patients and, where possible, strategies should be created to mitigate the additional risks and costs
Summary
The impact of obesity and increased body mass index (BMI) upon health services is a growing concern both nationally and internationally [1]. Elective orthopaedic surgery affords the opportunity for the balance of risk and adequate preparation of the patient; this is rarely the case in trauma surgery. Orthopaedic injury is common in major trauma, with 78% of severely injured patients having significant fracture related injury [2]. The prevalence of obesity is increasing globally [1], with 13% of the world’s population classed as obese, a threefold increase over the last years [3]. These trends mean that the obese patient with significant orthopaedic trauma requiring surgery is a regular presentation in orthopaedic trauma practice
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