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The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center
  1. Allen K Chen,
  2. David Jeffcoach,
  3. John C Stivers,
  4. Kyle A McCullough,
  5. Rachel C Dirks,
  6. Ryland J Boehnke,
  7. Lawrence Sue,
  8. Amy M Kwok,
  9. Mary M Wolfe,
  10. James W Davis
  1. Department of Surgery, University of San Francisco-Fresno, Fresno, California, USA
  1. Correspondence to Dr Allen K Chen, Department of Surgery, University of San Francisco-Fresno, Fresno, California 93721, USA; achen{at}fresno.ucsf.edu

Abstract

Background The 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.

Methods Patient 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.

Results During 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.

Conclusions Contrary 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 Evidence 3.

  • trauma and obesity
  • abdominal trauma
  • liver injury
  • spleen injuries

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Presented at Preliminary results presented October 4, 2017, at the Committee on Trauma, American College

    of Surgery, Oakland, CA.

  • Contributors AKC, DJ, and JWD conceived the idea for the study. AKC, JCS, KM, and RB contributed toward data collection. RD performed statistical analysis and development of all figures and tables. The manuscript was written by AKC, RD, and JWD. The article was reviewed and edited by LPS, AMK, and MMW.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article.

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