Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
Centre for Trauma Sciences, Blizard Institute of Cell and Molecular Biology, Queen Mary University of London, London, United Kingdom.
Injury. 2023 Feb;54(2):469-480. doi: 10.1016/j.injury.2022.10.026. Epub 2022 Oct 26.
The physiological abnormalities relating to obesity and metabolic syndrome can contribute to worse outcomes following trauma especially in class 2 and 3 obesity. The aim of this systematic review was to determine whether patients with a higher class of obesity who suffer traumatic injury have a higher risk of worse outcomes including in-hospital mortality than normal-weight patients.
A systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL was performed for studies that reported a comparison of in-hospital obesity-related outcomes against normal-weight individuals aged 15 years and older following trauma. Single or multiple injuries from either blunt and/or penetrating trauma were included. Burn-related injuries, isolated head injury and studies focusing on orthopaedic related perioperative complications were excluded.
The search yielded 7405 articles; 26 were included in this systematic review. 945,511 patients had a BMI>30. A random-effects meta-analysis was performed for analysis of all four outcomes. Patients with class 3 obesity (BMI>40) have significantly higher odds of in-hospital mortality than normal-BMI individuals following blunt and penetrating trauma (OR, 1.75; 95% CI, 1.39-2.19, p=<0.00001), significantly longer hospital LOS (SMD, 0.23; 95% CI, 0.21-0.25; p<0.00001) and significantly longer ICU LOS (SMD, 0.19; 95% CI, 0.12-0.26; p<0.0001). In contrast, studies that examined blunt and penetrating trauma and classified obesity with a threshold of BMI>30 found no significant difference in the odds of in-hospital mortality (OR, 0.94; 95% CI, 0.86-1.02, p=0.13).
There is a higher risk of in-hospital mortality in patients living with class 3 obesity following trauma when compared with individuals with normal BMI. The management of patients with obesity is complex and trauma systems should develop specific weight related pathways to manage and anticipate the complications that arise in these patients. Systematic review registration number PROSPERO registration: CRD42021234482 Level of Evidence: Level 3.
肥胖和代谢综合征相关的生理异常可能导致创伤后预后更差，尤其是在 2 类和 3 类肥胖患者中。本系统综述的目的是确定遭受创伤的肥胖程度更高的患者是否比正常体重患者有更高的风险出现更差的结局，包括院内死亡率。
对 MEDLINE、EMBASE、CENTRAL、Web of Science 和 CINAHL 进行了系统检索，以查找比较创伤后与正常体重个体相比肥胖相关结局的研究。纳入的研究包括来自钝性和/或穿透性损伤的单一或多处损伤。不包括烧伤相关损伤、单纯性头部损伤和专注于骨科围手术期并发症的研究。
检索得到 7405 篇文章；26 篇文章被纳入本系统综述。3945511 名患者 BMI>30。对所有 4 项结局进行了随机效应荟萃分析。3 类肥胖（BMI>40）患者在钝性和穿透性创伤后院内死亡率明显高于正常 BMI 个体（OR，1.75；95%CI，1.39-2.19，p<0.00001），住院 LOS 明显更长（SMD，0.23；95%CI，0.21-0.25；p<0.00001），ICU LOS 明显更长（SMD，0.19；95%CI，0.12-0.26；p<0.0001）。相比之下，研究钝性和穿透性创伤并将肥胖分类为 BMI>30 的阈值，发现院内死亡率的几率无显著差异（OR，0.94；95%CI，0.86-1.02，p=0.13）。
与正常 BMI 个体相比，肥胖 3 类患者创伤后院内死亡率更高。肥胖患者的管理很复杂，创伤系统应制定特定的与体重相关的途径来管理和预测这些患者出现的并发症。系统评价注册号：PROSPERO 注册：CRD42021234482 证据水平：3 级。
