Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures

Brian C. Werner, Justin W. Griffin, Scott Yang, Stephen F. Brockmeier, F. Winston Gwathmey

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database. Methods: Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90days and mortality within 2years postoperatively. Odds ratios and 95% confidence intervals were calculated. Results: From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. Ineachoperative group, obesity was associated with a substantial increase in local and systemic complications. Conclusions: Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.

Original languageEnglish (US)
Pages (from-to)593-600
Number of pages8
JournalJournal of Shoulder and Elbow Surgery
Volume24
Issue number4
DOIs
StatePublished - Apr 1 2015

Fingerprint

Humerus
International Classification of Diseases
Obesity
Hemiarthroplasty
Arthroplasty
Body Mass Index
Current Procedural Terminology
Databases
Intramedullary Fracture Fixation
Morbid Obesity
Nails
Comorbidity
Public Health
Odds Ratio
Confidence Intervals
Mortality

Keywords

  • Hemiarthroplasty
  • Humeral intramedullary nail
  • Level III
  • Obesity
  • Open reduction and internal fixation
  • Proximal humerus fracture
  • Retrospective cohort design from large database
  • Reverse total shoulder arthroplasty
  • Treatment study

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery
  • Medicine(all)

Cite this

Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures. / Werner, Brian C.; Griffin, Justin W.; Yang, Scott; Brockmeier, Stephen F.; Gwathmey, F. Winston.

In: Journal of Shoulder and Elbow Surgery, Vol. 24, No. 4, 01.04.2015, p. 593-600.

Research output: Contribution to journalArticle

Werner, Brian C. ; Griffin, Justin W. ; Yang, Scott ; Brockmeier, Stephen F. ; Gwathmey, F. Winston. / Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures. In: Journal of Shoulder and Elbow Surgery. 2015 ; Vol. 24, No. 4. pp. 593-600.
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abstract = "Background: Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database. Methods: Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90days and mortality within 2years postoperatively. Odds ratios and 95{\%} confidence intervals were calculated. Results: From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0{\%}) open reduction and internal fixation, 1368 (9.2{\%}) intramedullary nail, 3391 (16.7{\%}) hemiarthroplasty, and 727 (3.6{\%}) shoulder arthroplasty. Overall, 3794 patients (18.7{\%}) were coded as obese, morbidly obese, or body mass index >30. Ineachoperative group, obesity was associated with a substantial increase in local and systemic complications. Conclusions: Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.",
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T1 - Obesity is associated with increased postoperative complications after operative management of proximal humerus fractures

AU - Werner, Brian C.

AU - Griffin, Justin W.

AU - Yang, Scott

AU - Brockmeier, Stephen F.

AU - Gwathmey, F. Winston

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N2 - Background: Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database. Methods: Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90days and mortality within 2years postoperatively. Odds ratios and 95% confidence intervals were calculated. Results: From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. Ineachoperative group, obesity was associated with a substantial increase in local and systemic complications. Conclusions: Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.

AB - Background: Obesity has become a significant public health concern in the United States. The goal of this study was to assess the effect of obesity on postoperative complications after operative management of proximal humerus fractures by use of a national database. Methods: Patients who underwent operative management of a proximal humerus fracture were identified in a national database by Current Procedural Terminology codes for procedures in patients with International Classification of Diseases, Ninth Revision (ICD-9) codes for proximal humerus fracture, including (1) open reduction and internal fixation, (2) intramedullary nailing, (3) hemiarthroplasty, and (4) total shoulder arthroplasty. These groups were then divided into obese and nonobese cohorts by use of ICD-9 codes for obesity, morbid obesity, or body mass index >30. Each cohort was then assessed for local and systemic complications within 90days and mortality within 2years postoperatively. Odds ratios and 95% confidence intervals were calculated. Results: From 2005 to 2011, 20,319 patients who underwent operative management of proximal humerus fractures were identified, including 14,833 (73.0%) open reduction and internal fixation, 1368 (9.2%) intramedullary nail, 3391 (16.7%) hemiarthroplasty, and 727 (3.6%) shoulder arthroplasty. Overall, 3794 patients (18.7%) were coded as obese, morbidly obese, or body mass index >30. Ineachoperative group, obesity was associated with a substantial increase in local and systemic complications. Conclusions: Obesity and its resultant medical comorbidities are associated with increased rates of postoperative complications after operative management of proximal humerus fractures. Obese patients for whom operative management of proximal humerus fractures is planned should be counseled preoperatively about their increased risk for postoperative complications.

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KW - Open reduction and internal fixation

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KW - Retrospective cohort design from large database

KW - Reverse total shoulder arthroplasty

KW - Treatment study

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