Complications of acetabular fracture surgery in morbidly obese patients

Objectives: To compare the early complications with operative treatment of acetabular fractures in morbidly obese (body mass index >= 40) patients when compared with all other patients. Design: Retrospective review. Setting: University medical center. Patients/Participants: Four hundred thirty-five consecutive patients with acetabular fractures operatively treated by a single surgeon. Forty-one of these patients were morbidly obese (group 1) and were compared with the remaining patients (group 2). Group 2, therefore, included patients who were clinically overweight and obese. Intervention: Operative repair of acetabular fracture. Main Outcome Measurements: Outcome variables included patient positioning time, total operative time, estimated intraoperative blood loss, length of hospital stay, perioperative complications, and late complications. Results: The average total operative time was 293 minutes for group 1 and 250 minutes (P = 0.008) for group 2. The hospital stay for group 1 averaged 26 days versus 15 days in group 2 (P < 0.01). There were 19 (46%) wound complications in group 1 compared with 49 (12%) in group 2 (P < 0.0001). Overall, there were complications in 26 of the 41 patients (63%) in group 1 and in 96 of the 394 patients (24%) in group 2. Group 1's relative risk of having a complication was 2.6 (95% confidence interval = 2.4-2.8) when compared with group 2. Conclusions: Our morbidly obese population had a statistically higher complication rate, longer operative times, and greater estimated intraoperative blood loss. The majority of complications were related primarily to wound healing problems and successfully controlled with aggressive approach to surgical debridement.