Fri., 10/19/07 Pelvis, Paper #27, 11:28 am OTA-2007
Elevated BMI Increases Complications of Surgical Treatment of Pelvic Ring Injuries
S. Andrew Sems, MD1 (n); David C. Templeman, MD2 (e-Zimmer, Stryker; c-Zimmer);
Michael Johnson, MD3 (n); Peter A. Cole, MD3 (a-EBI/Biomet, DePuy, Synthes, Smith+Nephew, Zimmer; b-Synthes, Smith+Nephew, Zimmer); the Minnesota Orthopaedic Trauma Group;
1Mayo Clinic, Rochester, Minnesota, USA;
2Hennepin County Medical Center, Minneapolis, Minnesota, USA;
3Regions Hospital–University of Minnesota, St. Paul, Minnesota, USA
Purpose: The purpose of this study is to evaluate the relationship between body mass index (BMI) and postoperative complications including the need for reoperation following surgical treatment of pelvic ring injuries.
Methods: A retrospective review of 182 consecutive pelvic ring injuries (OTA code 61) surgically treated at three Level I trauma centers was performed. All patients were followed until clinical and radiographic union of the injuries (minimum 3 months). Complications that were evaluated included wound infection, loss of fixation, iatrogenic nerve injury, deep vein thrombosis (DVT), pneumonia, and the development of decubitus ulcers. BMI was calculated for each patient, and a BMI >30 kg/m2 considered to be obese, as defined by the National Institutes of Health. There were 133 males and 49 females, with an average age of 36.4 years (range, 14-83).
Results: There were 48 (26%) patients with BMI >30 kg/m2. Complications occurred in 46/182 patients (25.3%), with 26 occurring in the 48 patients with BMI >30 (56.3% complication rate) and 20 occurring in the 134 patients with BMI <30 (14.9% complication rate). Complications included 20 infections (4 superficial and 16 deep), 20 losses of fixation, 5 DVT, 3 pulmonary embolism, 3 pneumonia, 2 decubitus ulcers, and 3 iatrogenic nerve injuries. Reoperation was required in 29 patients, with 15 irrigation and débridements, and 16 refixation procedures. All wound complications occurred following open approaches, of which 106/182 patients (58.2%) had open approaches to the anterior pelvic ring, 64/182 (35.2%) had open approaches to the posterior pelvic ring, and 80/182 (44.0%) had percutaneous treatment of the posterior pelvic ring. Multivariate logistic modeling analyzing BMI as a continuous variable found a relationship between increasing BMI and complication rate (P = 0.0003), and need for reoperation (P = 0.0087). Odds ratios analysis revealed that obese patients (BMI >30) were 6.73 (95% confidence interval [CI] 3.21-14.12) times more likely to have a complication and 4.68 (95% CI 2.03-10.76) times more likely to need reoperation than patients with BMI <30.
Conclusion and Significance: BMI correlates with an increased rate of complications and need for reoperation after operative treatment of pelvic ring injuries.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.