*Departments of Anesthesiology and Public Health Sciences and †Department of Public Health Sciences, University of Rochester School of Medicine, Rochester, NY ‡Department of Surgery, University of Vermont Medical College §Center for Health Policy Research, Department of Medicine, University of California, Irvine; and ¶RAND, RAND Health, Boston, MA.
Ann Surg. 2014 Mar;259(3):576-81. doi: 10.1097/SLA.0000000000000330.
To examine the association between obesity and outcomes in injured patients.
The United States is facing an obesity epidemic affecting 1 in 3 adult Americans. Very little is known about the role of obesity in acute illness. Optimal care of obese trauma patients can only be achieved once we gain a better understanding of the impact of severe obesity on trauma outcomes.
We conducted a retrospective cohort study of 147,680 patients admitted to 28 level I and level II Pennsylvania trauma centers between 2000 and 2009. Logistic regression was used to examine the association between obesity and in-hospital mortality and major complications, adjusting for injury severity, age, gender, mechanism of injury, systolic blood pressure, and the motor component of the Glasgow Coma Scale, comorbidities, and year of admission. Patients were grouped into predefined weight categories: underweight (<1st percentile), reference (1st-74th percentile), grade 1 obesity (75th-90th percentile), grade 2 obesity (91th-95th percentile), grade 3 obesity (96th-99th percentile), and grade 4 obesity (>99th percentile). Body mass index was not calculated because height data was not available.
After adjusting for injury severity and other risk factors, male patients with severe obesity-grade 3 obesity [adjusted odds ratio (AOR) 1.28; 95% confidence interval (CI): 1.00, 1.64; P = 0.052] or grade 4 obesity (AOR 2.30; 95% CI: 1.48, 3.58; P < 0.001)-were more likely to die than nonobese patients. Severe obesity was associated with an approximately twofold higher risk of major complications: male patients with grade 3 obesity (AOR 1.71; 95% CI: 1.48, 1.97; P < 0. 001) or grade 4 obesity (AOR 2.14; 95% CI: 1.83, 2.51; P < 0.001). Similar results were obtained for female patients. Male and female patients with severe obesity had a 2.5- to 4-fold higher risk of developing acute renal failure. Severely obese females had 2.5- to 4.5-fold higher risk of developing wound complications, and a 4-to 8-fold higher risk of developing decubiti.
Severely obese trauma patients were at least 30% more likely to die and approximately twice as likely to have a major complication compared with nonobese patients.
探讨肥胖与受伤患者结局的关系。
美国正面临着肥胖症流行的问题，每 3 个成年美国人中就有 1 人肥胖。关于肥胖症在急性疾病中的作用，我们知之甚少。只有在更好地了解严重肥胖对创伤结局的影响后，才能为肥胖创伤患者提供最佳治疗。
我们对 2000 年至 2009 年间在宾夕法尼亚州 28 个一级和二级创伤中心入院的 147680 名患者进行了回顾性队列研究。使用 logistic 回归分析肥胖症与院内死亡率和主要并发症之间的关系，同时调整了损伤严重程度、年龄、性别、损伤机制、收缩压和格拉斯哥昏迷量表的运动成分、合并症和入院年份等因素。患者被分为预先设定的体重类别：体重不足（<第 1 百分位）、参考（第 1-74 百分位）、1 级肥胖（第 75-90 百分位）、2 级肥胖（第 91-95 百分位）、3 级肥胖（第 96-99 百分位）和 4 级肥胖（>第 99 百分位）。由于身高数据不可用，因此未计算体重指数。
在调整损伤严重程度和其他危险因素后，男性严重肥胖（3 级肥胖）[校正比值比（AOR）1.28；95%置信区间（CI）：1.00，1.64；P = 0.052]或 4 级肥胖（AOR 2.30；95% CI：1.48，3.58；P < 0.001）患者的死亡率高于非肥胖患者。严重肥胖与主要并发症的风险增加约两倍相关：男性 3 级肥胖（AOR 1.71；95% CI：1.48，1.97；P < 0.001）或 4 级肥胖（AOR 2.14；95% CI：1.83，2.51；P < 0.001）患者。女性患者也得到了类似的结果。严重肥胖的男性和女性患者发生急性肾衰竭的风险增加 2.5-4 倍。严重肥胖的女性发生伤口并发症的风险增加 2.5-4.5 倍，发生压疮的风险增加 4-8 倍。
与非肥胖患者相比，严重肥胖的创伤患者的死亡率至少增加 30%，发生主要并发症的风险约增加两倍。
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