Obesity Associated with Increased Postoperative Pulmonary Complications and Mortality after Trauma Laparotomy

Covarrubias, Jose; Grigorian, Areg; Schubl, Sebastian; Gambhir, Sahil; Dolich, Matthew; Lekawa, Michael; Nguyen, Ninh T.; Nahmias, Jeffry

doi:10.1016/j.jamcollsurg.2019.08.665

Cited by 4 publications

(8 citation statements)

References 27 publications

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“…Mortality was substantially higher in the obese group (4.2% vs. 6.5%, p = 0.010). Hospital LOS and ventilator day were also significantly longer in patients with obesity (9 [6-14] vs. 9 [7][8][9][10][11][12][13][14][15][16], p < 0.001 and 3 [2][3][4] vs. 3 [2][3][4][5], p = 0.015, respectively). There was no difference in in-hospital complications, except for a higher incidence of pneumonia for the patients with obesity (1.7% vs. 3.5%, p = 0.005).…”

Section: Resultsmentioning

confidence: 99%

“…Obesity was also associated with a higher rate of pulmonary complications in blunt trauma. 11,12 The major strength of this study was the use of a large US trauma data bank, which represented a very high volume of trauma patients. Moreover, this study focused on isolated abdominal gunshot injuries which excluded other associated body region injuries.…”

Section: Discussionmentioning

confidence: 99%

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Impact of obesity on outcomes after abdominal gunshot injury

Owattanapanich

Lewis

Schellenberg

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:The impact of obesity, on outcomes after a gunshot wound, remains unclear. We hypothesized that patients with obesity have a higher burden of intraabdominal injuries after gunshot injury when compared with the nonobese population. METHODS:The Trauma Quality Improvement Program database (2013-2017) was queried for all patients age ≥16 with abdominal gunshot injuries. Patients who died in the emergency department (ED), arrived without signs of life, had Abbreviated Injury Scale score ≥ 3 in any other region, or transferred from an outside hospital were excluded. The patient with obesity was defined by a body mass index ≥ 30. Demographics, injury data, and outcomes were abstracted and analyzed. Patients with obesity were compared to those with a body mass index < 30. Multivariate logistical regression was used to compare mortality between groups. RESULTS: Of 34,138 patients with gunshot injuries, there were 2,616 (7.7%) with isolated abdominal injuries. Median age is 29 years (22-39 years), 86.7% men. Eight hundred twenty-seven (31.6%) were obese. The obese group was significantly older (32 [25-42] vs. 27 [22-37]; p < 0.001) with a higher incidence of hypertension (16.8% vs. 6.3%, p < 0.001) and diabetes mellitus (7.1% vs. 2.3%, p < 0.001). There was no difference in presenting vital signs, abdominal Abbreviated Injury Scale or Injury Severity Score between groups. The rate of superficial injuries and intraabdominal organ injuries were comparable between groups. Patients with obesity had significantly higher mortality (6.5% vs. 4.2%, p = 0.010), hospital length of stay (9 [7-16] vs. 9[6-14], p < 0.001), ventilator days (3 [2-5] vs. 3 [2-4], p = 0.015), and hospital-acquired pneumonia (3.5% vs. 1.7%, p = 0.005). On multivariate analysis, in addition to older age (odds ratio [OR], 1.050; p < 0.001), ED hypotension (OR, 3.192; p < 0.001), and ED tachycardia (OR, 3.714; p < 0.001), obesity was significantly associated with mortality (OR, 1.636; p = 0.021). CONCLUSION:Patients with obesity are at a high risk of mortality after abdominal gunshot injury. Further prospective evaluation is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of obesity on outcomes after abdominal gunshot injury

Owattanapanich

Lewis

Schellenberg

et al. 2021

J Trauma Acute Care Surg

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“…The same has been demonstrated to be true from trauma of all mechanisms. 10,11,41,42 Even without untoward stressors, obese patients are affected by more challenging airway management, reduced lung compliance and volumes, and hypoventilation or apnea syndromes resulting in chronic hypoxemia. 40 The ramifications from this contribute to higher rates of ARDS, respiratory complications and longer duration of mechanical ventilation in obese patients following trauma.…”

Section: Discussionmentioning

confidence: 99%

“…40 The ramifications from this contribute to higher rates of ARDS, respiratory complications and longer duration of mechanical ventilation in obese patients following trauma. 41,42 Overall, these factors contribute to higher mortality in obese patients who sustain penetrating thoracoabdominal injuries. Importantly, this finding is not limited to penetrating thoracoabdominal injuries investigated in this study.…”

Section: Discussionmentioning

confidence: 99%

“The armor phenomenon” in obese patients with penetrating thoracoabdominal injuries: A systematic review and meta-analysis

Chen

Lee

Hsu

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Obesity represents a growing global health threat, which generally portends increased morbidity and mortality in the context of traumatic injuries. We hypothesized that there may exist a protective effect related to increased weight and truncal girth provided for obese patients in penetrating torso injuries, although this may not exert a significant positive impact overall upon clinical outcomes. METHODS:A comprehensive review of the literature was conducted across five databases up to March 2021 (Medline, Pubmed, Embase, Web of Science and the Cochrane library) to examine the effect of obesity on penetrating thoracoabdominal injuries. The primary outcome was to determine the rate of nonsignificant injury and injury patterns. Secondary outcomes examined were lengths of stay, complications, and mortality. Comparisons were drawn by meta-analysis. The study protocol was registered with PROSPERO under CRD42020216277. RESULTS:There were 2,952 publications assessed with 12 meeting the inclusion criteria for review. Nine studies were included for quantitative analysis, including 5,013 patients sustaining penetrating thoracoabdominal injuries, of which 29.6% were obese. Obese patients that sustained stab injuries underwent more nontherapeutic operations. Obese patients that sustained gunshot injuries had longer intensive care and total hospital length of stay. Obese patients suffered more respiratory complications and were at an increased risk of death during their admission. CONCLUSION:The "armor phenomenon" does not truly protect obese patients, a population that experiences increased morbidity and mortality following penetrating thoracoabdominal injuries.

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“…In the setting of blunt chest trauma, obese patients had higher respiratory complications including pneumonia (53). Following traumatic laparotomy, overweight, severely obese, and morbidly obese patients had a higher rate of pneumonia compared to normal weight patients (4.9%, 7.1%, and 8.5% vs. 3.2%, respectively) (54). Additionally, obese, severely obese, and morbidly obese patients had higher rate of pulmonary embolism compared to normal weight patients (2.2%, 2.6%, 3.7% vs. 0.9%).…”

Section: Morbiditymentioning

confidence: 99%

The Impact of Obesity on Critical Illnesses

Ayalon

Bodilly

Kaplan

2021

Shock

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In the last few decades, obesity became one of the world's greatest health challenges reaching a size of global epidemic in virtually all socioeconomic statuses and all age groups. Obesity is a risk factor for many health problems and as its prevalence gradually increases is becoming a significant economic and health burden. In this manuscript we describe how normal respiratory and cardiovascular physiology is altered by obesity. We review past and current literature to describe how obesity affects outcomes of patients facing critical illnesses and discuss some controversies related to this topic.

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Obesity Associated with Increased Postoperative Pulmonary Complications and Mortality after Trauma Laparotomy

Cited by 4 publications

References 27 publications

Impact of obesity on outcomes after abdominal gunshot injury

Impact of obesity on outcomes after abdominal gunshot injury

“The armor phenomenon” in obese patients with penetrating thoracoabdominal injuries: A systematic review and meta-analysis

The Impact of Obesity on Critical Illnesses

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