https://www.selleckchem.com/products/RO4929097.html Paradoxically, overweight and obesity are associated with lower odds of complications and death after hip fracture surgery. Our objective was to determine whether this "obesity paradox" extends to patients with "super-obesity." In this study, we compared rates of complications and death among super-obese patients with those of patients in other body mass index (BMI) categories. Using the National Surgical Quality Improvement Program database, we identified >100,000 hip fracture surgeries performed from 2012-2018. Patients were categorized as underweight (BMI <18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), obese (BMI 30-39.9), morbidly obese (BMI 40-49.9), or super-obese (BMI ≥50). We analyzed patient characteristics, surgical characteristics, and 30-day outcomes. Using multivariate regression with normal-weight patients as the referent, we determined odds of major complications, minor complications, and death within 30 days by BMI category. Of 440 super-obese patients, 20% had major complications, 33% had minor complications, and 5.2% died within 30 days after surgery. When comparing patients in other BMI categories with normal-weight patients, super-obese patients had the highest odds of major complications (odds ratio [OR] 1.6, 95% confidence interval [CI], 1.2-2.0) but did not have significantly different odds of death (OR 0.91, 95% CI, 0.59-1.4) or minor complications (OR 1.2, 95% CI, 0.94-1.4). Super-obese patients had significantly higher odds of major complications within 30 days after hip fracture surgery compared with all other patients. This "obesity paradox" did not apply to super-obese patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. To identify if timing to surgery was related to major 30-day morbidity and mortality rates in