The Effect of Obesity on Inpatient Outcomes in Lower Extremity Trauma: A Systematic Review and Meta-analysis.

Abstract

OBJECTIVES\nObesity is a growing global health problem and a well-recognized risk factor for many medical conditions. This meta analysis was conducted to assess the effect of obesity on overall complication occurrence, mortality and hospital length of stay in patients with nonpathological lower limb trauma.\n\n\nDATA SOURCES\nThe EMBASE, PUBMED and MEDLINE electronic databases were searched from inception to 1 April 2020 for studies published in English. References cited by chosen studies were also checked manually for inclusion.\n\n\nSTUDY SELECTION\nStudies chosen for the analysis were prospective observational or retrospective cohort studies reporting on total complications of patients with acute traumatic, non-pathological, lower limb fractures that required internal fixation, with or without other underlying conditions.\n\n\nDATA EXTRACTION\nTwo investigators independently reviewed the full text of eligible studies for inclusion and extracted data. Inconsistency was resolved through consultation with other authors.\n\n\nDATA SYNTHESIS\n16 studies with 404,414 patients were investigated in this study. The data showed obesity was related with increased total complications (OR = 0.65, 95%CI 0.51, 0.83, p < 0.01), increased wound complications (OR = 0.41, 95%CI 0.25, 0.66, p < 0.01), and increased mortality rate (OR = 0.64, 95%CI 0.45, 0.91, p < 0.05). Six cohort studies also showed prolonged hospital length of stay in obese patients.\n\n\nCONCLUSIONS\nOur results suggest that obesity is associated with increased complication and mortality rates, as well as longer hospital length of stay in patients with lower limb trauma who required surgical treatment. These findings may raise attention to optimize surgical technique and develop individualized treatment for obese patients.\n\n\nSTUDY TYPE\nSystematic Reviews.\n\n\nLEVEL OF EVIDENCE\nLevel III.