Dynamic Cushioning: Obesity and Trauma Patients Undergoing Exploratory Laparotomy.

BACKGROUND

Traumatic injuries account for 10% of all mortalities in the United States. Annually the global estimated population of overweight and obese individuals rises in number. It is well established in the literature that obesity is associated with worse outcomes in trauma patients. While body mass index, or BMI is not an independent predictor of increased morbidity or mortality after trauma laparotomy, we hypothesized that it may place patients at increased risk of postoperative complications and have lasting significant negative effects on quality of life in a manner disproportionate to normal-weight patients.

METHODS

The trauma registry of an academic level 1 trauma hospital was queried for laparotomies following either blunt or penetrating traumatic injury from 2015 to 2019. Individual patient charts were reviewed. Patients were divided into three groups, according to Body Mass Index (BMI) cut-offs as normal weight (BMI < 25 kg/m), overweight; BMI 25-29.9 kg/m), and obese (BMI ≥ 30 kg/m). Demographics, intraoperative management and outcomes were compared between groups, after which complications were regressed based on BMI to evaluate the impact BMI had on each.

RESULTS

Records of 197 trauma patients who underwent exploratory laparotomies were analyzed. There was no significant difference in demographics or injury severity score (ISS) between groups. BMI had a direct positive association with intensive care unit length of stay (r = 0.239 [0.103, 0.367]), P < 0.001), hospital length of stay (r = 0.197 [0.059, 0.328], P = 0.005) and return to OR (OR = 1.057, [1.010, 1.109], P = 0.017). There was no significant relationship between BMI and in-hospital or 90-d mortality.

CONCLUSIONS

Our findings show that with increasing BMI, postoperative complications increase following laparotomy for trauma. As rates of obesity increase, trauma surgeons must be prepared to anticipate plans of care from patient presentation to well beyond discharge to cope with more complex postoperative and post-hospital clinical courses.