Elsevier

Injury

Volume 44, Issue 9, September 2013, Pages 1145-1152
Injury

The effect of obesity on outcomes in trauma patients: A meta-analysis

https://doi.org/10.1016/j.injury.2012.10.038Get rights and content

Abstract

Objective

This study aims to assess the effect of obesity on injury severity score (ISS), mortality and course of hospital stay among trauma patients.

Method

A systematic review of the literature was conducted by Internet search. Data were extracted from included studies and analysed using a random-effects model to compare outcomes in the obese (body mass index (BMI)  30 kg m−2) with the non-obese (BMI < 30 kg m−2) group.

Result

Eventually, 18 studies met our inclusion criteria with 7751 obese patients representing 17% of the pooled study population. The data revealed that obesity was associated with increased risk of mortality, longer stay in the intensive care unit and higher rates of complication. Additionally, obese patients seemed to have longer duration of mechanical ventilation and hospital length of stay but it did not reach statistical significance. No difference was observed in ISS between the two groups.

Conclusion

Evidence strongly supports the correlation of obesity with worse prognosis in trauma patients and further studies should target this kind of population for therapy and prevention.

Section snippets

Search strategy

This study was conducted according to the guideline from the meta-analysis of observational studies in epidemiology (MOOSE) group.18 English-language articles published in Web of Science, PubMed and Cochrane Library up to June 2012 were searched using the following strategy: (‘obesity’ or ‘obese’ or ‘body mass index’) and (‘trauma’ or ‘injury’). References cited by chosen articles were checked manually for any other potential studies.

Study selection and data extraction

Studies chosen for the analysis fulfilled the following

Results

Our search strategy identified 2073 potentially relevant publications. Twenty-six of these publications met the inclusion criteria after the abstract review and were chosen for a full-text review. Upon closer examination, another eight studies were ruled out for the following reasons: definition of obesity using a different criterion (BMI > 40 kg m−2)26, 27; use of overlapping data with a smaller cohort and a shorter study period21, 28; inclusion of patients with specific injury patterns (such as

Discussion

There were two meta-analyses in past 5 years investigating the outcomes in obese patients in the critical care setting.33, 34 To our knowledge, despite strong heterogeneity among studies about the influence of obesity in trauma patients, there has been no meta-analysis in this field. The reason for the discrepancy in prior published studies had not been fully elucidated. A common shortcoming of these studies was that a substantial number of patients had to be excluded because of the lack of

Conclusion

The evidence presented here strongly supports the association of obesity with higher mortality in trauma patients despite comparable injury severity. The post-injury course for obese trauma patients is more complicated, characterised by extended ICU length of stay and increased rate of ARDS, acute renal failure and MOF. These findings might lead to potential therapeutic targets to improve outcomes in obese trauma patients.

Conflict of interest

This studied was supported by the Ministry Of Health Industry Special Fund of China (NO. 201002014) and the National key Technology R&D Program (Grant NO. 2012BAI11B00). The study was also funded by Wuhan Planning Project of Science and Technology (NO. 201161038339-03).

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