Orthopaedic Surgery Department, Hamad General Hospital, Doha, Qatar.
Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, United States.
Injury. 2022 Jul;53(7):2519-2523. doi: 10.1016/j.injury.2022.03.059. Epub 2022 Mar 27.
The objective of this study was to evaluate the effect of obesity on outcomes following operative treatment of fractures in obese polytrauma patients.
This was a prospective cohort study at a level I trauma centre from January 2014 until December 2017. The eligibility criteria were adult (age >= 18 years) polytrauma patients who presented with at least one orthopaedic fracture that required operative fixation. Polytrauma was defined as having an Injury Severity Score (ISS) >= 16. Out of 891 patients, a total of 337 were included with 85 being obese. The primary outcome variable was the total hospital length of stay in days. The secondary outcome variables were the number of patients who had an intensive care unit (ICU) admission, the ICU length of stay in days, the number of patients who had mechanical ventilation, the duration of mechanical ventilation in days, perioperative complications, and mortality.
Obesity was associated with increased total hospital stay (36 vs. 27 days; P<0.001), increased ICU stay (13 vs. 8 days; P = 0.04), increased ICU admissions (83.5% vs. 68.6%; P = 0.008) and increased incidence of mechanical ventilation (64.7% vs. 43.7%; P = 0.001). These findings remained statistically significant following adjusted regression models for age, gender, ISS, and injuries sustained. However, the mechanical ventilation duration was not significantly different between both groups on adjusted and unadjusted analyses. However, an increase per unit BMI significantly increases the duration of mechanical ventilation (P = 0.02). In terms of complications, obesity was only associated with an increase in acute renal failure (ARF) on unadjusted analyses (P = 0.004). Whereas, adjusted logistic regression demonstrated that an increase per BMI unit led to a significant increase in the odds ratio for wound infection (P = 0.03) and ARF (P = 0.024).
This study displayed that obesity was detrimental to polytrauma patients with operatively treated fractures leading to prolonged hospital and ICU length of stay. This highlights the importance of optimizing trauma care for obese polytraumatized patients to reduce morbidity. With 41.1% of our population being obese, obesity presents a unique challenge in the care of polytrauma patients which mandates further research in improving health care for this population group.
本研究旨在评估肥胖对接受手术治疗的肥胖多发伤患者骨折转归的影响。
这是一项在 I 级创伤中心进行的前瞻性队列研究，时间为 2014 年 1 月至 2017 年 12 月。纳入标准为：年龄≥18 岁、至少存在一处需要手术固定的骨科骨折的成年多发伤患者。多发伤定义为损伤严重度评分（ISS）≥16。在 891 例患者中，共有 337 例符合条件，其中 85 例肥胖。主要转归变量为住院总天数。次要转归变量包括入住重症监护病房（ICU）的患者人数、ICU 住院天数、需要机械通气的患者人数、机械通气时间、围手术期并发症和死亡率。
肥胖与住院总天数增加（36 天比 27 天；P＜0.001）、ICU 住院天数增加（13 天比 8 天；P=0.04）、ICU 入住率增加（83.5%比 68.6%；P=0.008）和机械通气发生率增加（64.7%比 43.7%；P=0.001）相关。这些发现经年龄、性别、ISS 和受伤类型的校正回归模型调整后仍具有统计学意义。然而，两组患者的机械通气时间在调整前后均无显著差异。然而，每单位 BMI 的增加显著增加机械通气时间（P=0.02）。在并发症方面，肥胖仅与未调整分析中的急性肾损伤（ARF）增加相关（P=0.004）。而调整后的逻辑回归显示，每单位 BMI 增加与伤口感染（P=0.03）和 ARF（P=0.024）的比值比显著增加相关。
本研究显示，肥胖对接受手术治疗的骨折多发伤患者不利，导致住院和 ICU 住院时间延长。这突显了优化肥胖多发伤患者创伤护理的重要性，以降低发病率。我们的人群中有 41.1%肥胖，肥胖对多发伤患者的护理提出了独特的挑战，这需要进一步研究如何改善这一人群的医疗保健。
