Impact of Obesity in the Critically Ill Trauma Patient: A Prospective Study

Bochicchio, Grant V.; Joshi, Manjari; Bochicchio, Kelly; Nehman, Shelly; Tracy, J. Kathleen; Scalea, Thomas M.

doi:10.1016/j.jamcollsurg.2006.07.001

Cited by 212 publications

(157 citation statements)

References 23 publications

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“…In comparing normal BMI to a BMI of 30-39.9 with an ISS ≥ 16 there is a 1.72 odds ratio for pneumonia and 1.82 for urinary tract infections [4]. In the ICU population 61% of obese patients had infections compared to 34% in the non-obese group [1]. Another study found that obesity was a predictor of nosocomial infections in trauma patients with an OR=4.69 [14].…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with findings from other studies that have examined the outcomes of trauma patients with comorbid obesity. Overall, obese patients have twice the relative risk of developing sepsis, UTI, or respiratory infections in the trauma/ICU setting [1]. In comparing normal BMI to a BMI of 30-39.9 with an ISS ≥ 16 there is a 1.72 odds ratio for pneumonia and 1.82 for urinary tract infections [4].…”

Section: Discussionmentioning

confidence: 99%

“…In the United States, the obesity rate has continued to increase over the last twenty years resulting in a national epidemic [1,2]. From 2011 to 2012, 35% of adults in the United States met criteria to be considered obese [3].…”

Section: Introductionmentioning

confidence: 99%

“…Recent literature exploring the link between obesity and trauma has shown increased morbidity and complications in obese trauma patients [1,4,7,8,9]. However, despite abundant literature on obesity, the results of studies looking at trauma outcomes and how they may be impacted by obesity are inconsistent [10].…”

Section: Introductionmentioning

confidence: 99%

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Infectious complications in obese patients after trauma

Bell

Bayt

Siedlecki

et al. 2016

Journal of Surgical Research

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Background: Obesity is a public health concern in the U.S. due to its increasing prevalence, especially in younger age groups. Trauma is the most common cause of death for people under 40 years of age. The purpose of this study is to determine the association between obesity and specific infectious complications following traumatic injury. Materials and Methods:A retrospective analysis was conducted using data from the 2012 National Trauma Data Bank (NTDB). The NTDB defined obesity as having a BMI of 30 or greater. Descriptive statistics were calculated and stratified by obesity status. A hierarchical regression model was used to determine the odds of experiencing an infectious complication in patients with obesity while controlling for age, gender, diabetes, number of comorbidities, injury severity, injury mechanism, head injury, and surgical procedure. Results:Patients with a BMI of 30 or greater compared to non-obese patients had increased odds of having an infectious complication (OR=1.59, 1.49-1.69). In addition to obesity, ISS greater than 29, age 40 years or older, diabetes, comorbid conditions, and having a surgical procedure were also predictive of an infectious complication. Conclusions:Our results indicate that trauma patients with obesity are nearly 60% more likely to develop an infectious complication in the hospital. Infection prevention and control measures should be implemented soon after hospital arrival for patients with obesity, particularly those with operative trauma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infectious complications in obese patients after trauma

Bell

Bayt

Siedlecki

et al. 2016

Journal of Surgical Research

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“…Several studies have indicated that obese trauma patients are more likely than nonobese patients to have longer stays in the intensive care unit (ICU) 7,[9][10][11] and hospital, 9,11-13 more days of mechanical ventilation, 7,14 more complications 7,9,[15][16][17][18] and comorbid conditions, 16 and higher mortality. 7,16,[18][19][20][21][22] Other studies have indicated no differences between obese and nonobese patients in mortality, 10,11,17,[23][24][25][26] length of stay in the ICU 13,27 and the hospital, 20,22,26 duration of mechanical ventilation, 11,13,27 complications, 11,22,24,26 or comorbid conditions. 3 Care of critically ill trauma patients is resource intensive, technically involved, and expensive because of the need for highly trained staff and modern equipment and the use of diagnostic tests, pharmaceutical agents, and interventions.…”

mentioning

confidence: 99%

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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Background Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. Objectives To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. Methods A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. Results In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. Conclusions Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

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