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Objective: We aimed to characterize the association between BMI as a continuous variable and 30-day postoperative outcomes following hip fracture surgery through (1) 30-day readmission and reoperation; (2) local wound-related; and (3) systemic complications.

Methods: The National Surgical Quality Improvement Program database (January 2016-December 2019) was queried for patients undergoing hip fracture open reduction and internal fixation. Baseline patient demographics, comorbidities, and patient outcomes were recorded. Multivariable regression models accounted for baseline demographics, comorbidities, and fracture patterns. Significant associations were analyzed using spline regression models to evaluate the continuous association between BMI and the aforementioned outcomes.

Results: Spline models demonstrated a U-shaped curve for the odds of 30-day readmission and 30-day reoperation with nadirs at the BMI of 27.5 and 22.0 kg/m 2 . The odd ratios of superficial infection, deep infection, any wound complication, and inability to weight bear on POD 1 rose progressively starting at a BMI of 25.6, 35.5, 25.6, and 32.7 kg/m 2 respectively. Odds of 30-day mortality, transfusion, pneumonia, and delirium were greatest at the lowest recorded BMI (11.9 kg/m 2 ).

Conclusion: BMI has a U-shaped association with 30-day readmission and reoperation. Conversely, the highest risk of mortality and systemic complications (transfusion, pneumonia, and delirium) were within the lower BMI range, with diminishing risk as BMI increased. Local wound complications and systemic sepsis exhibited a third unique pattern with progressive rise in odds as BMI increased. The odds of any complications demonstrated a U-shaped pattern with a nadir in the overweight to obese I categories, suggesting that patients may be at lowest risk within this range.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Competing Interests: The authors report no conflict of interest.

Titel:	Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients.
Autor/in / Beteiligte Person:	Emara, AK ; Oyem, PC ; Ferre, A ; Churchill, J ; Grits, D ; Ng, M ; Pan, X ; Nagy, M ; Obiri-Yeboah, D ; Molloy, RM ; Piuzzi, NS
Zeitschrift:	Journal of orthopaedic trauma, Jg. 37 (2023-07-01), Heft 7, S. 315-322
Veröffentlichung:	Hagerstown, MD : Lippincott Williams & Wilkins ; <i>Original Publication</i>: [New York, N.Y.] : Raven Press, [c1987-, 2023
Medientyp:	academicJournal
ISSN:	1531-2291 (electronic)
DOI:	10.1097/BOT.0000000000002581
Schlagwort:	Humans Body Mass Index Postoperative Complications epidemiology Postoperative Complications etiology Regression Analysis Retrospective Studies Risk Factors Hip Fractures surgery Hip Fractures complications Delirium complications
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [J Orthop Trauma] 2023 Jul 01; Vol. 37 (7), pp. 315-322. MeSH Terms: Hip Fractures* / surgery ; Hip Fractures* / complications ; Delirium* / complications ; Humans ; Body Mass Index ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Regression Analysis ; Retrospective Studies ; Risk Factors References: The World Health Organization (WHO). Obesity and Overweight. [Internet]. The World Health Organization News Room. 2021. [cited 2021 Jul 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. ; Vincent HK, Seay AN, Vincent KR, et al . Effects of obesity on rehabilitation outcomes after orthopedic trauma. Am J Phys Med Rehabilitation. 2012;91:1051–1059. ; Parratte S, Pesenti S, Argenson JN. Vol 100. Elsevier Masson; 2014:S91–S97.Obesity in orthopedics and trauma surgeryOrthop Traumatology Surg Res. ; Roth A, Anis HK, Emara AK, et al. The potential effects of imposing a body mass index threshold on patient-reported outcomes after total knee arthroplasty. J Arthroplasty. 2021;36:S198–S208. ; Afolabi HA, Zakariya Zbin, Ahmed Shokri AB, et al. The relationship between obesity and other medical comorbidities. Obes Med. 2020;17:100164. ; PI-SUNYER FX. Comorbidities of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31suppl 1:S602. ; Sundaram K, Warren J, Anis H, et al. An increased body mass index was not associated with higher rates of 30-day postoperative complications after unicompartmental knee arthroplasty. The Knee. 2019;26:720–728. ; Roth A, Khlopas A, George J, et al. The effect of body mass index on 30-day complications after revision total hip and knee arthroplasty. J Arthroplasty. 2019;34:S242–S248. ; Akinleye SD, Garofolo G, Culbertson MD, et al . The Role of BMI in hip fracture surgery. Geriatric Orthop Surg Rehabilitation. 2018;9:215145851774741. ; Armstrong ME, Spencer EA, Cairns BJ, et al. Body mass index and physical activity in relation to the incidence of hip fracture in postmenopausal women. J Bone Mineral Res. 2011;26:1330–1338. ; Modig K, Erdefelt A, Mellner C, et al . Obesity paradox” holds true for patients with hip fracture. J Bone Jt Surg. 2019;101:888–895. ; George J, Piuzzi NS, Ng M, et al . Association between body mass index and thirty-day complications after total knee arthroplasty. J Arthroplasty. 2018;33:865–871. ; Werner BC, Evans CL, Carothers JT, Browne JA. Primary total knee arthroplasty in super-obese patients: dramatically higher postoperative complication rates even compared to revision surgery. J Arthroplasty. 2015;30:849–853. ; Fuchshuber PR, Greif W, Tidwell CR, et al. The power of the national surgical quality improvement program—achieving A zero pneumonia rate in general surgery patients. Perm J. 2012;16:39–45. ; American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2018 ACS NSQIP Participant Use Data File. PUF; 2019. ; 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. ; Neuman HB, Michelassi F, Turner JW, Bass BL. Surrounded by quality metrics: what do surgeons think of. Surgery. 2009;145:27–33. ; 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. ; Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-level prevalence of adult obesity and severe obesity. New Engl J Med. 2019;381:2440–2450. ; Chaudhry YP, Rao SS, Puvanesarajah V, et al. Complications and 30-day mortality rate after hip fracture surgery in superobese patients. J Orthop Trauma. 2021;35:322–328. ; Mulla ZD. Spline regression in clinical research. West Indian Med J. 2007;56:77–79. ; Edwards LJ, Stewart PW, MacDougall JE, Helms RW. A method for fitting regression splines with varying polynomial order in the linear mixed model. Statistics Med. 2006;25:513–527. ; Acuña AJ, Grits D, Samuel LT, et al . Perioperative blood transfusions are associated with a higher incidence of thromboembolic events after TKA: an analysis of 333,463 TKAs. Clin Orthop Relat Research®. 2021:10–1097. Entry Date(s): Date Created: 20230214 Date Completed: 20230616 Latest Revision: 20230828 Update Code: 20240513

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Is High Body Mass Index Protective or Detrimental in Surgical Fixation of Hip Fractures?: A Spline Regression Analysis of 22,388 Patients.