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The Impact of Obesity on Severity of Solid Organ Injury in the Adult

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The Impact of Obesity on Severity of Solid Organ Injury in the Adult Open access Original article Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2019-000318 on 12 July 2019. Downloaded from The impact of obesity on severity of solid organ injury in the adult population at a Level I trauma center Allen K Chen, David Jeffcoach, John C Stivers, Kyle A McCullough, Rachel C Dirks, Ryland J Boehnke, Lawrence Sue, Amy M Kwok, Mary M Wolfe, James W Davis Department of Surgery, ABSTRact of stay (LOS), and pulmonary dysfunction found University of San Francisco- Background The obese (body mass index, BMI > in obese patients with trauma. However, a recent Fresno, Fresno, California, USA 30) have been identified as a subgroup of patients in study evaluated the impact of obesity on solid organ regards to traumatic injuries. A recent study found that injury among pediatric patients.4 Vaughan et al, Correspondence to Dr Allen K Chen, Department high-grade hepatic injuries were more common in obese performed a multi-centered prospective analysis, of Surgery, University of San than non-obese pediatric patients. This study seeks to evaluating 117 pediatric patients with solid organ Francisco-Fresno, Fresno, evaluate whether similar differences exist in the adult injury after blunt abdominal trauma, and found California 93721, USA; achen@ population and examine differences in operative versus pediatric obese patients were more likely to sustain fresno. ucsf. edu non-operative management between the obese and non- a high-grade hepatic injury (grade 4 or 5) with Preliminary results presented obese in blunt abdominal trauma. no difference in the rate of severe splenic injury. October 4, 2017, at the Methods Patient with trauma evaluated at an Boulanger et al also evaluated solid organ injury in Committee on Trauma, American American College of Surgeons verified Level I trauma the obese adult population and reported a decrease Collegeof Surgery, Oakland, CA. center from February 2013 to November 2016 were in the incidence of all hepatic injuries in the obese 5 Received 22 March 2019 retrospectively reviewed. All patients aged >18 years population. This study evaluated all injury patterns Revised 6 May 2019 with blunt mechanism of injury and a BMI listed in the between obese and non-obese patients with blunt Accepted 11 May 2019 trauma registry were included. Patients were excluded trauma, and also found there were no differences for incomplete data, including BMI or inability to grade in intra-abdominal injuries with the exception of hepatic or splenic injury. Data collected included age, decreased hepatic injuries. gender, BMI, injury severity score, hospital length of Differing injury patterns in the obese population stay, procedures on liver or spleen, and mortality. Organ has affected prognosis and management in patients copyright. injuries were scored using the American Association with trauma. Therefore, we sought to evaluate solid for the Surgery of Trauma grading scales, and were organ injuries in the obese adult population. determined by either imaging or intraoperative findings. Obesity was classified as BMI > 30 compared with non- obese with BMI < 30. METHODS Results During the study period, 9481 patients were A retrospective study was performed on adult included. There were 322 spleen injuries and 237 liver patients (≥18 years of age) evaluated at Community injuries, with 64 patients sustaining both liver and Regional Medical Center, an American College of splenic injuries. No differences existed in the percentage Surgeons-verified Level I trauma center in Fresno, of high-grade hepatic or splenic injuries between the California, from February 2013 through November http://tsaco.bmj.com/ obese and non-obese. Obese patients with liver injuries 2016. Patients with blunt mechanism injury and were more likely to have procedural intervention than a body mass index (BMI) recorded in the trauma non-obese liver injuries and had higher rates of mortality. registry were included and categorized as obese No differences were found in intervention for splenic (BMI ≥30) or non-obese (BMI <30) based on the injury between obese and non-obese. Center for Disease Control and Prevention’s defi- Conclusions Contrary to prior studies on adult and nition of obesity.6 Patients with incomplete data, pediatric patients with trauma, this study found no including missing BMI or inability to grade spleen difference between obese and non-obese patients in or liver injury, were excluded from analysis. on September 29, 2021 by guest. Protected severity of solid organ injury after blunt abdominal Obese and non-obese patients were compared trauma in the adult population. However, there was an on age, gender, mechanism of injury, injury severity increased rate of procedural intervention and mortality score (ISS), liver and spleen injury scores, angioem- for obese patients with liver injuries. bolization or operative interventions, hospital LOS, Level of Evidence 3. and mortality. Hepatic and splenic injuries were graded by imaging or intraoperative findings using the American Association for the Surgery of Trauma © Author(s) (or their organ injury scaling system.7–9 In cases with discrep- employer(s)) 2019. Re-use permitted under CC BY-NC. No INTRODUCTION ancies between imaging and intraoperative findings, commercial re-use. See rights A global increase in the prevalence of obesity has the injuries were scored based on the intraoperative and permissions. Published increased interest in the obese patient as a subgroup findings. by BMJ. in the medical field. In the field of trauma surgery, Categorical data are presented as percentages and To cite: Chen AK, there have been multiple studies that have identi- continuous data are presented as mean±SD. Data Jeffcoach D, Stivers JC, et al. fied outcomes and injury patterns unique to obese were analyzed using Mann-Whitney U-test and χ2 Trauma Surg Acute Care Open patients.1–3 Many of these studies have focused on analysis. Logistic regression was used to calculate 2019;4:e000318. morbidity and mortality outcomes, hospital length the predicted probability for angioembolization Chen AK, et al. Trauma Surg Acute Care Open 2019;4:e000318. doi:10.1136/tsaco-2019-000318 1 Open access Trauma Surg Acute Care Open: first published as 10.1136/tsaco-2019-000318 on 12 July 2019. Downloaded from Table 1 Patient demographics Table 2 Patient demographics, obese vs non-obese Non-obese Obese Non-obese Obese (BMI <30) (BMI ≥30) P value (BMI <30) (BMI ≥30) P value N 6953 2528 – Liver (n) 182 55 – Male gender 4756 (68%) 1632 (64%) <0.001 BMI 25±3 35±6 <0.001 Age 50±22 48±18 0.40 Age 37±15 40±16 0.20 Body mass index 24.7±3.1 35.1±5.2 <0.001 Male gender 132 (72%) 37 (67%) 0.45 Injury severity score 11±9 10±9 0.001 Mechanism of Injury Mechanism of Injury Assault 4 (2%) 0 0.27 Assault 690 (10%) 164 (6%) <0.001 Fall 9 (5%) 1 (2%) 0.31 Fall 2517 (36%) 811 (32%) <0.001 Motorcycle collision 11 (6%) 3 (6%) 0.87 238 (3%) 100 (4%) 0.22 Motor vehicle collision 129 (71%) 50 (91%) 0.002 Motorcycle collision Pedestrian/bike versus auto 14 (8%) 0 0.034 Motor vehicle collision 2159 (31%) 971 (38%) <0.001 Other 15 (8%) 1 (2%) 0.096 Pedestrian/bike versus auto 280 (4%) 88 (4%) 0.22 Injury severity score 23±12 27±15 0.17 Other 1069 (15%) 394 (16%) 0.80 Severe injury (grade 4/5) 33 (18%) 7 (13%) 0.35 Liver injury 182 (3%) 55 (2%) 0.22 Spleen (n) 231 91 – Spleen injury 231 (3%) 91 (4%) 0.51 BMI 24.6±3.2 35.3±4.8 <0.001 Hospital length of stay 5.6±9.5 5.6±8.6 0.84 Age 40±18 43±16 0.09 Mortality 288 (4%) 84 (3%) 0.069 Male gender 162 (70%) 65 (71%) 0.82 BMI, body mass index. Mechanism of Injury Assault 29 (13%) 3 (3%) 0.012 Fall 20 (9%) 8 (9%) 0.97 at each BMI. Multivariate regression was used to adjust for Motorcycle collision 12 (5%) 11 (12%) 0.031 confounding variables. Statistics were performed using the Statis- Motor vehicle collision 135 (58%) 62 (68%) 0.11 tical Package for Social Sciences (SPSS V.23.0, IBM) with signifi- Pedestrian/bike vs auto 14 (6%) 2 (2%) 0.15 cance attributed to a p value of <0.05. This study was performed copyright. with the approval of the Institutional Review Board of Commu- Other 21 (9%) 5 (6%) 0.29 nity Medical Centers/UCSF Fresno. Injury severity score 21±12 24±15 0.40 Severe injury (grade 4/5) 44 (19%) 25 (28%) 0.097 RESUltS BMI, body mass index. During the study period, 10 525 patients ≥18 years of age were seen at our institution following blunt traumatic injury. Of these, 1044 were excluded for missing data and 9481 were included in Obese patients with liver injuries had an increased rate of the analysis. intervention compared with the non-obese group (36% vs 22%, Overall, there were 6953 non-obese patients and 2528 obese p=0.032), with the primary difference found in the rates of patients. Demographics and outcomes are listed in table 1. There interventional radiology embolization (9% vs 2%, p=0.019). http://tsaco.bmj.com/ was a significant difference in BMI (p<0.001) between the obese No difference in surgical intervention of the liver was observed and non-obese population which is to be expected. There were between obese and non-obese patients (29% vs 20%, p=0.17). no differences found in age, LOS, mortality, or incidence of For splenic injuries, there were no differences found in the rates liver and spleen injuries between obese and non-obese patients.
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