The Impact of Obesity on Surgical Outcomes in Burst Fractures: A Retrospective Statewide Analysis

Introduction: Burst fractures are severe vertebral injuries that often require surgical intervention. Pre-injury factors, such as severe obesity, may influence the management and outcomes of these fractures. While obesity is a known risk factor in various surgical procedures, its specific impact as a pre-injury factor on burst fracture management remains unclear. This study aims to quantify the association between body mass index (BMI), particularly severe obesity, and the likelihood of surgical intervention in patients with burst fractures.

Methods: We conducted a retrospective cohort study using a statewide institutional database comprising 177 patients from 2018 to 2023 who presented to a Level 1 Trauma Center with vertebral fracture injuries. Patients were categorized by BMI according to Centers for Disease Control and Prevention (CDC) guidelines: underweight (BMI < 18.5 kg/m²), normal weight (BMI 18.5–24.9 kg/m²; reference group), overweight (BMI 25.0–29.9 kg/m²), obesity Class I (BMI 30.0–34.9 kg/m²), and severe obesity (Classes II and III). Severe obesity was defined as a BMI ≥ 35 kg/m² with comorbidities or BMI ≥ 40 kg/m² without comorbidities. Demographic and clinical characteristics were compared using Chi-square and Fisher’s exact tests. Multivariable logistic regression analyses were conducted to identify factors determining surgical versus medical management, adjusting for potential confounders. The primary outcome was the need for surgical intervention.

Results: Severe obesity, as a pre-injury factor, was significantly associated with increased odds of surgical intervention (odds ratio [OR] 5.9; 95% confidence interval [CI]: 1.46–23.91; p = 0.013). Underweight patients (OR 1.64; 95% CI: 0.19–14.52; p = 0.656), overweight patients, and those with obesity Class I (OR 1.36; 95% CI: 0.34–5.43; p = 0.664) did not show a statistically significant difference compared to the normal BMI group.

Conclusion : Severe obesity—as defined by a BMI ≥ 35 kg/m² with comorbidities or BMI ≥ 40 kg/m² without comorbidities—significantly increases the likelihood of surgical intervention in patients with burst fractures. This finding underscores the importance of considering pre-injury severe obesity and associated comorbidities in pre-surgical counseling, risk assessment, and resource allocation. Recognizing severe obesity as a critical factor can aid clinicians in optimizing management strategies for burst fractures.