The Effect of an Abnormal BMI on Orthopaedic Trauma Patients: A Systematic Review and Meta-Analysis

Aims: The aim of this systemic review is to identify the complications that arise in operating on orthopaedic trauma patients with an abnormal body mass index (BMI). Materials and Methods: Systematic literature search using a combination of MESH subject headings and free text searching of Medline, Embase, SCOPUS and Cochrane databases in August 2019. Any orthopaedic injury requiring surgery was included. Papers were reviewed and quality assessed by two independent reviewers to select for inclusion. Where sufficiently homogenous, meta-analysis was performed. Results: A total of 26 articles (379,333 patients) were selected for inclusion. All complications were more common in those with a high BMI (>30). The odds ratio (OR) for high BMI patients sustaining post-operative complication of any type was 2.32 with a 23% overall complication rate in the BMI > 30 group, vs. 14% in the normal BMI group (p < 0.05). The OR for mortality was 3.5. The OR for infection was 2.28. The OR for non-union in tibial fractures was 2.57. Thrombotic events were also more likely in the obese group. Low BMI (<18.5) was associated with a higher risk of cardiac complications than either those with a normal or high BMI (OR 1.56). Conclusion: Almost all complications are more common in trauma patients with a raised BMI. This should be made clear during the consent process, and strategies developed to reduce these risks where possible. Unlike in elective surgery, BMI is a non-modifiable risk factor in the trauma context, but an awareness of the complications should inform clinicians and patients alike. Underweight patients have a higher risk of developing cardiac complications than either high or normal BMI patient groups, but as few studies exist, further research into this group is recommended.

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Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-016-0649-6 ◽

2016 ◽

Vol 43 (3) ◽

pp. 329-336 ◽

Cited By ~ 2

Author(s):

A. C. Dodd ◽

N. Lakomkin ◽

V. Sathiyakumar ◽

W. T. Obremskey ◽

M. K. Sethi

Keyword(s):

Cardiac Complications ◽

Trauma Patients ◽

Orthopaedic Trauma

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Modulation of post-operative insulin resistance by pre-operative carbohydrate loading

Proceedings of The Nutrition Society ◽

10.1079/pns2002168 ◽

2002 ◽

Vol 61 (3) ◽

pp. 329-336 ◽

Cited By ~ 112

Author(s):

Olle Ljungqvist ◽

Jonas Nygren ◽

Anders Thorell

Keyword(s):

Insulin Resistance ◽

Heart Surgery ◽

Surgical Stress ◽

Elective Surgery ◽

Meta Analysis ◽

Open Heart Surgery ◽

Length Of Hospital Stay ◽

Cardiac Complications ◽

Intravenous Glucose ◽

Mortality And Morbidity

Insulin resistance develops as a response to virtually all types of surgical stress. There is an increasing body of evidence that suggests that insulin resistance in surgical stress is not beneficial for outcome. A recent large study in intensive-care patients showed that aggressive treatment of insulin resistance using intravenous insulin reduced mortality and morbidity substantially. Similarly, in burn patients, intensive insulin and glucose treatment has been shown to improve N economy and enhance skin-graft healing. In surgical patients insulin resistance has been characterized in some detail, and has been shown to have many similarities with metabolic changes seen in patients with type 2 diabetes. This finding may be important since insulin resistance has been shown to be one independent factor that influences length of stay. When patients about to undergo elective surgery have been treated with glucose intravenously or a carbohydrate-rich drink instead of overnight fasting, insulin resistance was reduced by about half. A small meta-analysis showed that when post-operative insulin resistance was reduced by preoperative carbohydrates, length of hospital stay was shortened. Overnight intravenous glucose at high doses improved post-operative N economy. This type of treatment has also been shown repeatedly to reduce cardiac complications after open-heart surgery. Furthermore, if the carbohydrates are given as a drink pre-operatively, pre-operative thirst, hunger and anxiety are markedly reduced. In summary, preventing or treating insulin resistance in surgical stress influences outcome. Fasting overnight is not an optimal way to prepare patients for elective surgery. Instead, pre-operative carbohydrates have clinical benefits.

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