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Lower extremity injuries following motor vehicle accidents more severe in obese patients

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SAN FRANCISCO — Individuals with a body mass index greater than 30 appear to have a higher risk for severe lower extremity injury in motor vehicle crashes, according to a study presented here.

The purpose of the study was to "gain a better understanding of the influence obesity has on the outcomes of patients who sustained lower extremity orthopedic trauma," said Rajshri Maheshwari, MD, of Seattle, who reported the findings at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

The investigators conducted a retrospective review of patients who sustained lower extremity injuries in automobile crashes and were evaluated at Level I trauma centers over a 10-year period (1996-2006). Obese patients — those who had a body mass index (BMI) greater than 30 — were compared to nonobese patients.

The data, collected from a multicenter database, included information on patients' length of hospital stay, severity of injury, complications, long-term health care needs and quality of life.

The researchers included 665 cases from the database, of which 206 cases (31%) were considered obese.

According to Maheshwari, "There was no significant difference in gender, injury mechanism, Injury Severity Score or Abbreviated Injury Score among the two patient groups.

The obese patients were, on average, slightly older than the nonobese patients and had a greater incidence of reported baseline cardiac disease and diabetes.

Obese patients also had more severe injury patterns in their distal femoral fractures compared to the nonobese patients. Likewise, obese patients had higher rates of cardiac, vascular, pulmonary and wound complications than the nonobese patients, but this was not statistically significant.

"We also found that obese patients were more likely to have a higher mortality rate and a need for skilled nursing home facilities afterwards, but that wasn't statistically significant," he said.

The length-of-hospital stay was the same among patients in both groups (11 days, mean), he added.

For more information:

• Maheshwari R, Nork SE, Henley MB, et al. The effect of obesity on outcomes among trauma patients with lower extremity orthopaedic injuries. Paper #141. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.