Midwest Surgical Association
Obesity in trauma: outcomes and disposition trends

https://doi.org/10.1016/j.amjsurg.2013.10.013Get rights and content

Abstract

Background

Obesity’s effect on the outcomes of trauma patients remains inconclusive.

Methods

A retrospective review of all falls, motor vehicle collisions (MVCs), and penetrating trauma patients admitted from January 2008 to December 2012 was performed. The outcomes evaluated included mortality, length of stay at hospital, and discharge disposition. Patients were grouped according to the body mass index (BMI) and stratified by injury severity scores.

Results

Two thousand one hundred ninety six patients were analyzed; 132 penetrating, 913 falls, and 1,151 MVCs. Penetrating traumas had no significant difference in outcomes. In falls, obese patients had a lower mortality (P = .035). In MVCs, obese patients had longer hospitalizations (P = .02), and mild and moderate MVC injuries were less likely to be discharged home (P = .032 and .003). Obese patients sustained fewer head injuries in falls and MVCs (P = .005 and .043, respectively).

Conclusions

In falls, a higher BMI may benefit patients. However, an increasing BMI is associated with a longer length of stay at hospital, and decreased likelihood of discharge to home.

Section snippets

Methods

A retrospective review of our prospective trauma registry at a state-designated, micro urban, Level I trauma center was used as the primary data source, on the basis of an institutional review board approved protocol. All trauma patients admitted between January 2008 and December 2012 were screened. Patients were excluded if they were under the age of 18 years, pregnant, or sustained burns. All patients who did not have a height, weight, and ISS documented in the registry were also excluded.

Results

The trauma registry contained 3,768 patients for the time period reviewed. Of these, 1,572 required exclusion by age, pregnancy, burn, or incomplete specification of height, weight, and ISS. The remaining 2,196 (58.3%) patients constitute the subjects of this analysis. Of the 1,151 patients injured by MVC, 381 (33.1%) were obese. Of the 913 patients injured by fall, 233 (25.4%) were obese. Of the 132 patients with penetrating injuries, 42 (31.8%) were obese (Fig. 1).

Comments

This study further highlights the complex problems in determining the effects of obesity on patterns of injury and outcomes in obese patients. This study is only descriptive and therefore unable to assess the effects of any particular treatment intervention. It relies on the assumption that injury mechanisms, evaluation, and management techniques are uniform between obese and nonobese populations. The formula for kinetic energy, k = (1/2) mv2, implies that velocity has a much greater effect on

Conclusions

This study demonstrates that the patterns of injury and outcomes for obese trauma patients may be distinct for different mechanisms of injury. We failed to demonstrate significant differences in mortality, LOS, or disposition for victims of penetrating trauma. However, despite similar mortality, obese patients injured by MVC suffered longer hospital stays, longer ICU stays, and more ventilator days than nonobese patients. We unexpectedly found that obese patients injured by a fall of <1 story

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    From these, twenty-six studies met the criteria for inclusion and were included in the final analysis (Fig. 1). Eleven studies reported on both blunt and penetrating trauma [4,22–31], nine studies reported on blunt trauma alone [5,14,32–40], three studies reported on penetrating trauma [41–43] and three studies reported on isolated thoracic blunt and penetrating trauma [13,44,45]. A consensus was agreed for the final number of studies for inclusion without the need for a third reviewer.

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The authors declare no conflicts of interest.

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