Effects of Obesity on Systemic Complications after Operative Pelvic Ring Fractures

Abstract

To determine the effect of obesity on systemic complications after operative pelvic ring injuries. Design: Retrospective cohort study Single level 1 trauma center All patients at a level 1 trauma center who underwent operative fixation of a pelvic ring injury from 2015-2022 were included. Patients were grouped based on body mass index (BMI) into four categories (normal = BMI <25, overweight = BMI 25-30, obese = BMI 30-40, and morbidly obese BMI >40). Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, ileus, acute kidney injury (AKI), myocardial infarction, and mortality were recorded. Patients who developed a complication were compared to those who did not in regard to demographic and clinical parameters to determine risk factors for each complication. A total of 1056 patients underwent pelvic ring fixation including 388 normal BMI, 267 overweight, 289 obese, and 112 morbidly obese patients. The average age of all patients was 36.9 years, with a range from 16 to 85 years. Overall, 631 patients (59.8%) were male. The overall complication and mortality rates were 23.2% and 1.4%, respectively. BMI was a significant independent risk factor for all-cause complication with an odds ratio (OR) of 1.67 for overweight, 2.30 for obese, and 2.45 for morbidly obese patients. The risk of DVT and AKI were also significantly increased with every weight class above normal with ORs of 5.06 and 3.02, respectively, for morbidly obese patients (BMI >40). This study demonstrated that among patients undergoing pelvic ring fixation, higher BMI was associated with increased risks of overall complication and specifically DVT and AKI. As the prevalence of obesity continues to increase in the population, surgeons should be cognizant that these patients may be at higher risk of certain post-operative complications during the initial trauma admission. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.