The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center

Abstract

BackgroundThe obese (body mass index, BMI > 30) have been identified as a subgroup of patients in regards to traumatic injuries. A recent study found that high-grade hepatic injuries were more common in obese than non-obese pediatric patients. This study seeks to evaluate whether similar differences exist in the adult population and examine differences in operative versus non-operative management between the obese and non-obese in blunt abdominal trauma.MethodsPatient with trauma evaluated at an American College of Surgeons verified Level I trauma center from February 2013 to November 2016 were retrospectively reviewed. All patients aged >18 years with blunt mechanism of injury and a BMI listed in the trauma registry were included. Patients were excluded for incomplete data, including BMI or inability to grade hepatic or splenic injury. Data collected included age, gender, BMI, injury severity score, hospital length of stay, procedures on liver or spleen, and mortality. Organ injuries were scored using the American Association for the Surgery of Trauma grading scales, and were determined by either imaging or intraoperative findings. Obesity was classified as BMI > 30 compared with non-obese with BMI < 30.ResultsDuring the study period, 9481 patients were included. There were 322 spleen injuries and 237 liver injuries, with 64 patients sustaining both liver and splenic injuries. No differences existed in the percentage of high-grade hepatic or splenic injuries between the obese and non-obese. Obese patients with liver injuries were more likely to have procedural intervention than non-obese liver injuries and had higher rates of mortality. No differences were found in intervention for splenic injury between obese and non-obese.ConclusionsContrary to prior studies on adult and pediatric patients with trauma, this study found no difference between obese and non-obese patients in severity of solid organ injury after blunt abdominal trauma in the adult population. However, there was an increased rate of procedural intervention and mortality for obese patients with liver injuries.Level of Evidence3.

Does a “Cushion Effect” Really Exist? A Morphomic Analysis of Vulnerable Road Users with Serious Blunt Abdominal Injury

“…It is defined as a BMI ≥ 30 kg/m 2 by adopting National Institutes of Health (NIH) and World Health Organization (WHO) guidelines [3,4]. It has been widely discussed in the trauma literature Healthcare 2021, 9, 1006 2 of 11 and studies have shown that obesity is associated with a higher risk for post-trauma complications and mortality [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19].…”

Complex Program of Diagnostics and Treatment of Polytraumatized Patients With Ii-Iii Degrees Obesity

“…The higher obesity grade the smaller percent of the instrumental diagnostic approaches reliability in such patients. This causes the necessity of more frequent implementation of the invasive methods, which, on the one hand improved the injuries verification, and on the other -provoked the risks of complications connected both with their implementation and intervention into the body cavities [1,6].…”

“…The scope of medical aid for the traumatized at the pre-hospital stage depended upon the subjective assessment of the patients' general condition by the emergency team. Polytraumatized patients were diagnosed and treated at hospital according to the common and local protocols, which included the collection and analysis of the complaints, medical history and features of the traumatizing factor [1,2,10].…”

“…The patients with the excess weight and different grades of obesity demand special approach among the multitude of the traumatized patients. Thus, as it was shown by some researchers, the overweight injured people suffer more in the course of traumatic disease as compared to the people with the normal weight [1,2,3]. Besides, the references provide only few publications as to the diagnostic characteristics and surgical treatment of the polytraumatized people against the obesity background, and there are practically no clear algorithms as to the diagnostic examination of such patients [4,5].…”

Obesity Effect on the Course of Abdominal Trauma

“…A.K. Chen et al found an increase in the frequency of interventions and mortality in patients with liver injury with increased BMI [6], while C.Y. Fu et al, in contrast, found that obesity reduced the incidence of blunt abdominal trauma and operations due to damage of the abdominal organs [7].…”