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The Impact of Obesity on Hand Surgery Complication Rates
Daniel A. London, BA; Jeffrey G. Stepan, BS; Gopal Lalchandani, BA; Ugochi C. Okoroafor, MD; Troy S. Wildes, MD; Ryan P. Calfee, MD, MSc
Washington University in St. Louis School of Medicine, St. Louis, MO

Introduction: Currently over 36% of United States adults are obese, a categorization linked to both general and orthopedic health problems. In lower extremity surgery, numerous studies have demonstrated heightened complication rates in obese patients, yet similar research in hand surgery is lacking. We sought to compare the rates of postoperative complications experienced by obese and non-obese hand surgical patients.
Materials and Methods: This was an IRB approved retrospective case-control study. From 2009-2013, 436 patients that received one type of hand surgery (bony, soft tissue, or nerve) with a BMI>35 were identified (cases). Controls were patients (n=433) with a BMI<30 who also had hand surgery over the same period, and they were frequency matched by age, gender, and type of surgery. Post-operative complications (i.e. the need for antibiotics post-operatively, infection, poor incision healing, nerve injury, wound dehiscence, hematoma, and reoperations) and medical comorbidities (i.e., hypertension, diabetes, stroke, vascular disease, kidney disease, and liver disease) were recorded. Chi-square analyses were performed to see if there was an association between being obese (BMI>35) and post-operative complications. Similar analyses were performed stratified on surgery type. Logistic regression modeling was performed to identify predictors of post-operative complications accounting for surgery type, BMI, the presence of comorbidities, patient age, and patient sex. The same model was also run separately for case and control patients.
Results: The overall complication rate was 8.7% with similar rates between obese and non-obese patients (8.5% vs 9.0%, p=0.79). An association exists between surgery type and developing post-operative complications in both obese and non-obese patients (Table 1, p<0.02). Multivariate analysis revealed surgery type as the only significant predictor of complications for non-obese patients (p<0.01). However, for the obese patients, both bony surgery (p=0.02) and increasing BMI (p=0.03) were associated with greater complication rates. Table 1. Complication rates by patient's BMI category and surgery type.

Conclusion: In general, obese patients do not appear to be at any higher risk for post-operative complications after hand surgery. However, there does appear to be a dose-response effect of BMI in obese patients such that greater obesity leads to greater risk of complications.

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