Body Mass Index and Mortality in Blunt Trauma: The Right BMI can be Protective

Choi, James; Smiley, Abbas; Latifi, Rifat; Gogna, Shekhar; Prabhakaran, Kartik; Con, Jorge; Anderson, Patrice; Policastro, A.J.; Beydoun, Malk; Rhee, Peter

doi:10.1016/j.amjsurg.2020.10.017

Cited by 12 publications

(17 citation statements)

References 24 publications

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“…In summary, the results from other populations for both long‐term (nine studies 93,143,178,182–187 ; 31,812 participants; Table S2; Figure S1) and short‐term (six studies 93,188–192 ; 517,818 participants; Figure S2) outcomes were similar to that of the categorized populations. Mortality risk was not significantly associated with BMI.…”

Section: Resultsmentioning

confidence: 52%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 52%

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…Literature regarding multiple trauma has shown an "obesity paradox", in which the overall survival seemed to be higher in obese patients than in underweight patients [29,30]. One study found that a BMI <18.4 kg/m 2 was associated with an increased risk of mortality after multiple trauma [30]. We surmised that a lower BMI indicated less subcutaneous fat coverage to cushion or protect neurovascular and bony structures.…”

Section: Amputationmentioning

confidence: 87%

“…A lower BMI was noted as a signi cant risk factor for amputation in our multivariate analysis. Literature regarding multiple trauma has shown an "obesity paradox", in which the overall survival seemed to be higher in obese patients than in underweight patients [29,30]. One study found that a BMI <18.4 kg/m 2 was associated with an increased risk of mortality after multiple trauma [30].…”

Section: Amputationmentioning

confidence: 99%

Predicting the Outcome of Open Type IIIC Tibial Fractures Regarding Union, Osteomyelitis, and Amputation

Chen

Lien

Lan

et al. 2021

Preprint

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Backgrounds: This study aimed to assess factors that affect union time and complications in Gustilo IIIC tibial fractures.Methods: Patients who presented to our center with IIIC open tibial fractures from January 2000 to October 2020 were eligible for this retrospective analysis. Patient demographics, fracture characteristics, timing, numbers, and type of surgical intervention were documented. Outcomes of interest included union time, occurrence of osteomyelitis, and amputation. Results: Fifty-eight patients were enrolled and grouped by fracture type; eight union on time (13.8%); 27 late union (46.6%); eight delayed union (13.8%); three nonunion (5.2%); and 12 amputation (20.7%). Nine fractures (15.5%) were complicated by osteomyelitis. Union time was prolonged in cases of triple arterial injury, distal third fractures, multiple trauma with Injury Severity Score (ISS) ≥ 16 points, and increased length of bone defect. Additionally, a bone gap > 50 mm, diabetes mellitus, low body mass index, and triple arterial injury in the lower leg were significant risk factors for amputation. A time from injury to definitive soft tissue coverage of more than 22 days was the major risk factor for osteomyelitis. A scoring system to predict union time was devised and the predicted probability of union within two years was stratified based on this score. Conclusions: IIIC tibial fractures involving the distal third of the tibia, fractures with bone defects, triple arterial injury, and multiple trauma with ISS ≥ 16 points demonstrated delayed union, and an effective prediction system for union time was introduced in this study. Early soft tissue coverage can reduce the risk of osteomyelitis. Finally, diabetes and severe bone and soft tissue defects pose a higher risk of amputation.

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“…A low BMI was a significant risk factor for amputation in the multivariate analysis. Literature regarding multiple trauma has shown an “obesity paradox,” in which overall survival appeared to be higher in obese patients than in underweight patients 30,31 . One study found that a BMI < 18.4 kg/m 2 was associated with increased mortality after multiple trauma 31 .…”

Section: Discussionmentioning

confidence: 99%

Predicting Union, Osteomyelitis, and Amputation Outcomes of Gustilo IIIC Open Tibial Fractures: A Retrospective Study

Chen,

Lien,

Lan

et al. 2023

Orthopaedic Surgery

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ObjectiveOpen tibial fractures are frequently encountered in high‐energy traumas and can result in significant complications such as nonunion, osteomyelitis, and even amputation. Among open tibial fractures, Gustilo type IIIC cases are particularly challenging due to the concomitant occurrence of neurovascular injuries and soft tissue defects. This study aimed to assess factors that affect union time and complications in Gustilo IIIC tibial fractures.MethodsPatients who presented at our center with IIIC open tibial fractures from January 2000 to October 2020 were eligible for this retrospective analysis. Patient demographics, fracture characteristics, and the timing, number, and type of surgical intervention were documented. Outcomes of interest included union time, occurrence of osteomyelitis, and amputation. We performed univariate analyses including chi‐squared test, Fischer's exact test, analysis of variance, and Kruskal–Wallis test based on the normality of the data and multivariate analyses including Cox proportional hazards model and logistic regression analyses.ResultsFifty‐eight patients were enrolled and grouped by fracture healing time; eight had timely union (13.8%); 27 had late union (46.6%); eight had delayed union (13.8%); three had nonunion (5.2%); and 12 underwent amputation (20.7%). Nine fractures (15.5%) were complicated by osteomyelitis. Union time was prolonged in cases of triple arterial injury, distal third fractures, multiple trauma with injury severity score (ISS) ≥ 16 points, and increased bone defect length. Additionally, a bone gap >50 mm, diabetes mellitus, low body mass index, and triple arterial injury in the lower leg were significant risk factors for amputation. A time from injury to definitive soft tissue coverage of more than 22 days was the major risk factor for osteomyelitis. A scoring system to predict union time was devised and the predicted probability of union within 2 years was stratified based on this score.ConclusionIIIC tibial fractures involving the distal third of the tibia, fractures with bone defects, triple arterial injury, and multiple trauma with ISS ≥16 points demonstrated delayed union, and an effective prediction system for union time was introduced in this study. Early soft tissue coverage can reduce the risk of osteomyelitis. Finally, diabetes and severe bone and soft tissue defects pose a higher risk of amputation.

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Body Mass Index and Mortality in Blunt Trauma: The Right BMI can be Protective

Cited by 12 publications

References 24 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Predicting the Outcome of Open Type IIIC Tibial Fractures Regarding Union, Osteomyelitis, and Amputation

Predicting Union, Osteomyelitis, and Amputation Outcomes of Gustilo IIIC Open Tibial Fractures: A Retrospective Study

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