The Impact of Obesity on the Outcomes of 1,153 Critically Injured Blunt Trauma Patients

Brown, Carlos; Neville, Angela; Rhee, Peter; Salim, Ali; Velmahos, George C.; Δημητριάδης, Δημήτριος

doi:10.1097/01.ta.0000189047.65630.c5

Cited by 223 publications

(184 citation statements)

References 7 publications

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“…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%

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: Introductionmentioning

confidence: 99%

Infectious complications in obese patients after trauma

Bell

Bayt

Siedlecki

et al. 2016

Journal of Surgical Research

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“…obez hastaların kırık paternlerinin daha ağır ve yumuşak doku hasarının daha fazla olduğunu bildirmişlerdir. [26] Gilbert ve ark. yapmış oldukları geriye dönük çocuk kırık analizinde obez çocuklarda fizisi içeren kırık oranının nonobez olanlara göre daha fazla olduğunu bildirmişlerdir.…”

Section: Introductionunclassified

The İmpact of Obesity on the Outcomes of the Patients that Operated due to Schatzker Type I and II ?

Çeçen

Gülabi

Pehlivanoğlu

et al. 2015

Ulus Travma Acil Cerrahi Derg

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ÖZET AMAÇ: Schatzker tip I ve tip II tibia plato kırıklarında tedavi sonuçlarının klinik ve radyolojik olarak değerlendirilmesi ve bu sonuçlara vücut kitle indeksinin (VKİ) etkisinin araştırılması. BULGULAR: Schatzker tip II olgularda Rasmussen klinik skorları ile yaş arasında ters yönde %48.4 düzeyinde istatistiksel olarak anlamlı ilişki bulunduğu saptandı (p<0.01). GEREÇ VE YÖNTEM: SONUÇ:Tip II kırıklarda obez hastaların klinik ve radyolojik sonuçları normal kilosu olan hastalara göre kötü olarak bulundu. Obezite kısa sürede çözümlenebilecek bir sorun olmadığı için bu gurup hastalarda tedavi başarısını artırmanın, ancak yakın takip ve rehabilitasyonun yeterince yapılması ile mümkün olabileceğini düşünmekteyiz.Anahtar sözcükler: Rasmussen skalası; tibia plato kırıkları; VKİ. GİRİŞObezite, görülme sıklığı giderek artan önemli bir toplumsal sağlık sorunu olmaya başlamıştır. [1,2] Vücut kitle indeksi (VKİ) tüm vücut ağırılığının (kilogram), kişinin boy uzunluğunun (metre) karesine bölünmesi sonucu (kg/m 2 ) olarak ölçülür. 30 kg/m 2 üstü kişiler obez olarak kabul edilir. Obezitenin, kişilerin genel sağlık durumları üzerine olumsuz etkileri daha önce birçok yazar tarafından bildirilmiştir.[3] Ortopedik cerrahide de spinal, diz ve kalça operasyonları sonrası obezitenin olumsuz etkileri gösterilmiştir. Obezitenin, perioperatif ve ameliyat sonrası yara problemleri ve DVT riskini artırdı-ğı görülmüştür. Weinlein JC ve ark. yapmış oldukları geriye dönük olgu-kontrol çalışmasında femoral şaft kırığı nedeniyle intramedüller çivileme yapılan hastalarda obezitenin, ameliyat sonrası morbidite üzerinde etkisi olduğunu göstermişlerdir. [4] Ancak yapmış olduğumuz İngilizce literatür taramasında VKİ ile plato tibia kırıkları arasındaki korelasyonu gösteren makale saptanmamıştır.Tibia lateral platosunu etkileyen Schatzker tip I ve tip II kı-rıklar, eklem içi kırıklar olup, eklem içi yaralanmalar da, kırığa eşlik edebilir. [5][6][7][8][9] Tedavide amaç, stabil, ağrısız ve fonksiyonları tam diz elde edilmesidir. Düşük enerjiyle oluşan tibia plato kırıklarında, konservatif tedavi yöntemleri yeterli olabilirken, yüksek enerjili travmalar sonrası oluşan plato kırıklarında eksternal fiksatör, açık redüksiyon ve internal tespit tek başına yapılabildiği gibi bunların bir arada kulanımları da mümkündür. Schatzker tip I ve tip II tibia kırıkları, birçok olguda vidalarla veya destek plakları kullanılarak başarılı şekilde tespit edilebilmektedir. [10,11] Özellikle obez bireylerde osteoartrit gelişim riskini unutmamak ve eklem içi kırıklarda iyi redüksiyonu sağ-lamak önemlidir. [12] Bu çalışmadaki amacımız son yıllarda sanayi, yüksekten düşme ve trafik kazaları sonucu sık rastlamış olduğumuz lateral tibia plato Schatzker tip I ve tip II kırıkların cerrahi (açık redüksiyon ve plak vida ile osteosentezi yapılmış) sonuçları üzerine VKİ etkisini araştırmaktı. Hipotezimiz ise VKİ≥ 30 kg/m 2 olan has-

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“…7,8 However, published reports on how obesity complicates hospital stays after trauma are conflicting. 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.…”

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confidence: 99%

“…29 In previous research on the effect of a patient's BMI on resource usage, each usage outcome was assessed independently of other resource usage variables. In those studies, 3,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]30 resource usage was evaluated as a secondary outcome by using familiar statistical analyses (t test, analysis of variance, regression analysis) suitable for the research questions. However, in order to best ascertain the association between the complex, multifaceted relationship of patient/ injury characteristics and hospital resource usage, the use of multivariate canonical correlation analyses is suggested.…”

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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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The Impact of Obesity on the Outcomes of 1,153 Critically Injured Blunt Trauma Patients

Cited by 223 publications

References 7 publications

Infectious complications in obese patients after trauma

Infectious complications in obese patients after trauma

The İmpact of Obesity on the Outcomes of the Patients that Operated due to Schatzker Type I and II ?

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

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