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J Hosp Med. 2009 Oct;4(8):E1-9. doi: 10.1002/jhm.527.

Body mass index (BMI) and risk of noncardiac postoperative medical complications in elderly hip fracture patients: a population-based study.

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Section of General Internal Medicine, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA.



Obese patients are thought to be at higher risk of postoperative medical complications. We determined whether body mass index (BMI) is associated with postoperative in-hospital noncardiac complications following urgent hip fracture repair.


We conducted a population-based study of Olmsted County, Minnesota, residents operated on for hip fracture in 1988 to 2002. BMI was categorized as underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (> or = 30 kg/m2). Postoperative inpatient noncardiac medical complications were assessed. Complication rates were estimated for each BMI category and overall rates were assessed using logistic regression modeling.


There were 184 (15.6%) underweight, 640 (54.2%) normal, 251 (21.3%) overweight, and 105 (8.9%) obese hip fracture repairs (mean age, 84.2 +/- 7.5 years; 80% female). After adjustment, the risk of developing an inpatient noncardiac complication for each BMI category, compared to normal BMI, was: underweight (odds ratio [OR], 1.33; 95% confidence interval [CI], 0.95-1.88; P = 0.10), overweight (OR, 1.01; 95% CI, 0.74-1.38; P = 0.95), and obese (OR, 1.28; 95% CI, 0.82-1.98; P = 0.27). Multivariate analysis demonstrated that an ASA status of III-V vs. I-II (OR, 1.84; 95% CI, 1.25-2.71; P = 0.002), a history of chronic obstructive pulmonary disease (COPD) or asthma (OR, 1.58; 95% CI, 1.18-2.12; P = 0.002), male sex (OR, 1.49; 95% CI, 1.10-2.02; P = 0.01), and older age (OR, 1.05; 95% CI, 1.03-1.06; P < 0.001) contributed to an increased risk of developing a postoperative noncardiac inpatient complication. Underweight patients had higher in-hospital mortality rates than normal BMI patients (9.3 vs. 4.4%; P = 0.01).


BMI has no significant influence on postoperative noncardiac medical complications in hip-fracture patients. These results attenuate concerns that obese or frail, underweight hip-fracture patients may be at higher risk postoperatively for inpatient complications.

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