In a recent study published in the Bone & Joint Surgery (JBJS) journal, a team of researchers determined that trauma patients who are also obese have higher total hospital charges, longer hospital stays, are more likely to be discharged to a continuing care facility, and have a higher rate of orthopedic surgical intervention than patients without obesity.
With obesity now affecting some 38% of the U.S. population, a greater proportion of trauma patients are likely to be obese and these patients present a greater healthcare burden.
For their study, titled “The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma,” researchers identified a group of 301 patients with multiple orthopedic — or musculoskeletal — trauma and intensive care unit admission at a Level-I trauma center between 2006 and 2011.
Of the total patients studied, 21.6% were classified as obese, with obesity measured using computer tomography scans and defined as a truncal body mass index (BMI) greater or equal to 30 kg/m2. These patients were then divided into two classes, with Class I comprising those with a BMI of 30 to 35 kg/m2, and Class II those with a BMI superior to 35 kg/m2. Patients with a BMI of less than 30 kg/m2 were classified as non-obese.
The need for an orthopedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the groups.
Obesity was found to increase the possibility of patients undergoing surgical intervention: 72% of obese patients compared to about 55% of non-obese patients. The level of obesity also had an effect on patients’ risk for surgical intervention: 67% of Class I patients and 93.3% of Class II patients underwent surgery.
Non-obese patients had mean shorter hospital stays (12.4 days) than obese patients (16.4 days), and spent less time in intensive care (mean stays of 7.2 days and 9.7 days, respectively). Mean hospital costs were $160,606 for patients without obesity and $234,863 for patients with obesity. The proportion of Class II obese patients discharged to a continuing care facility also was larger than that of other groups.
“Overall this study found an association between obesity and increased rates of lower-extremity injuries and orthopaedic surgery,” said study lead author and orthopedic surgeon Heather Licht, MD, in a news release. “Obese patients had higher total hospital charges, longer intensive care unit and total hospital stays, and decreased rate of discharge. Even when patients have the same severity of injuries, resource utilization is higher among patients with obesity, compared to non-obese patients.”