Author: Dr Tony Williams, Consultant Occupational Physician, Working Fit Ltd.
Date: August 2015.
There is evence that obesity is a risk factor for complications following many orthopaedic procedures. Obesity is also a risk factor with delayed healing and impaired immunity.
Following peri-acetabular osteotomy 280 patients were followed up and major complications were seen in 22% of obese patients and 3% of non-obese patients. Odds were 11 times higher (95% CI 4.71-17.60) (Novais et al., 2015).
A study of 436 patients with BMI over 35 who had hand, wrist, forearm or elbow surgery showed a dose-dependent effect of BMI on surgical complications (London et al., 2014).
There is increasing evidence for immune dysfunction associated with obesity. Adipose tissue can over-express the cytokine TNFα and this can in turn contribute to insulin resistance. Lymphocytes resident within adipose tissue (adipocytes) also produce adiponectin, resistin and visfatin. These all have immunological activity, and there is a close relationship between adipocytes and macrophage accumulation (Wellen and Hotamisligil, 2005).
There is evidence for impaired antibody responses in overweight individuals. The incidence and severity of specific types of infectious illnesses are higher in obese persons compared to lean individuals with the occurrence of poor antibody responses to antigens in overweight subjects. Leptin might play a key role in linking nutritional status with T-cell function (Marti et al., 2001).
Besides operative complications, a study of 564 patients having colon cancer resection found visceral obesity was shown to be a risk factor for pneumonia (p=0.02), anastomotic leakage (p=0.04), wound infection (p=0.03) and re-operations (p=0.04) (Cakir et al., 2015).
There is also an increased risk of chest infections with delayed mobilisation.