Complications and Failure to Rescue After Abdominal Surgery for Trauma in Obese Patients

Kaufman, Elinore J.; Hatchimonji, Justin S.; Lucy, W.; Passman, Jesse; Holena, Daniel N.

doi:10.1016/j.jss.2020.01.026

Cited by 5 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Compared to recent data in the literature [ 26 , 27 ] that reported on the association of obesity with morbidity and mortality in trauma patients, the mortality rate in our cohort was notably high. Given the very different risk profiles for complications and mortality of trauma patients, however, the high mortality rate indicated in this study is relative and attributable to the risk-based approach of patient selection.…”

Section: Discussioncontrasting

confidence: 93%

The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

Kassahun

Babel

2022

BMC Surg

View full text Add to dashboard Cite

Background Obesity has been shown to increase the rates of morbidity and occasionally mortality in patients undergoing nonbariatric elective surgery. However, little is known about the impact of obesity on outcomes after surgery for high-risk abdominal emergencies. Methods A single-center retrospective evaluation of outcomes in high-risk abdominal emergency patients categorized by body mass index (BMI) was conducted. Patient demographics, comorbidities, and operative details were analyzed. Patients with normal weight (BMI 18.5–24.9) served as comparators. Multivariable linear and logistic regression analyses were performed to assess the impact of obesity on surgical outcomes. Results In total, 886 patients with BMI < 18.5 (underweight; n = 50), 18.5–24.9 (normal weight; n = 306), 25–29.9 (overweight; n = 336) and ≥ 30 (obese; n = 194) based on the World Health Organization (WHO) weight classification criteria met the inclusion criteria. Compared to normal-weight patients, patients with overweight and obesity were older and more likely to be male. The rates of comorbidity (100% vs 91.2%, p = < 0.0001), morbidity (77.8% vs 65.6%, p = 0.003), and in-hospital mortality (44.8% vs 30.4%, p = 0.001) were all higher in patients with obesity than in normal-weight patients. Patients with obesity had an increased intensive care unit length of stay (ICU LOS) (13 days vs 9 days, p = 0.019) and hospital LOS (21.4 days vs 18.1 days, p = 0.081) and prolonged ventilation (39.1% vs 19.6%, p = 0.003). As BMI deviated from the normal range, the morbidity and mortality rates increased incrementally, with the highest morbidity (87.9%) and mortality (54.5%) rates observed in morbidly obese patients (BMI ≥ 40). Conclusions Patients with obesity were the most likely to have coexisting conditions, experience postoperative complications, and die during the first admission following EL for high-risk abdominal emergencies.

show abstract

Section: Discussioncontrasting

confidence: 93%

The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

Kassahun

Babel

2022

BMC Surg

View full text Add to dashboard Cite

show abstract

“…However, obesity was identified as a risk factor for developing pneumonia in abdominal trauma patients undergoing emergency surgery in a large register study with over 95,000 cases [30]. Here, up to 15% of obese patients developed postoperative pneumonia.…”

Section: Obesity-associated Comorbidities Affecting Postoperative Outcomesmentioning

confidence: 99%

Impact of Excess Body Weight on Postsurgical Complications

Plassmeier

Hankir

Seyfried³

2021

Visc Med

View full text Add to dashboard Cite

Background: Obesity is considered a risk factor for postoperative complications as it can limit exposure to the operation field, thereby significantly prolonging surgery time. Obesity-associated comorbidities, such as low-grade systemic inflammation, impaired functional status, and type 2 diabetes, are independent risk factors for impaired anastomotic wound healing and nonsurgical site infections. If obesity itself is an independent risk factor for surgical complications remains controversial, but the reason for this is largely unexplored. Summary: A MEDLINE literature search was performed using the terms: “obesity,” “excess body weight,” and “surgical complications.” Out of 65,493 articles 432 meta-analyses were screened, of which 25 meta-analyses were on the subject. The vast majority of complex oncologic procedures in the field of visceral surgery have shown higher complication rates in obese patients. Meta-analyses from the last 10 to 15 years with high numbers of patients enrolled consistently have shown longer operation times, higher blood loss, longer hospital stay for colorectal procedures, oncologic upper gastrointestinal (GI) procedures, and pancreatic surgery. Interestingly, these negative effects seem not to affect the overall survival in oncologic patients, especially in esophageal resections. A selection bias in oncologic upper GI patients may have influenced the results with higher BMI in upper GI cancer to be a predictor for better nutritional and performance status. Key Messages: Contrary to bariatric surgery, only limited evidence indicated that site and type of surgery, the approach to the abdominal cavity (laparoscopic vs. open), institutional factors, and the type of perioperative care such as ERAS protocols may play a role in determining postsurgical complications in obese patients. The initial question remains therefore partially unanswered. Large nationwide register-based studies are necessary to better understand which aspects of obesity and its related comorbidities define it as a risk factor for surgical complications.

show abstract

“…In the last decades the improvement of resuscitative strategies, including surgical and nonsurgical procedures, has allowed trauma surgeons to increase the success rate of these strategies in trauma patients. Unfortunately, failure to rescue is a well-known outcome for trauma and acute care surgeons [1][2][3]. In real-life experience, it is often difficult to focus the attention on possible outcomes not related to the patient's survival.…”

Section: Introduction 1organ Procurement After Damage Control Resusci...mentioning

confidence: 99%

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Altomare

Bekhor

Cioffi

et al. 2022

Life

View full text Add to dashboard Cite

Background: Organ donation (OD) remains the only therapeutic option for end-stage disease in some cases. Unfortunately, the gap between donors and recipients is still substantial. Trauma patients represent a potential yet underestimated pool of organ donors. In this article, we present our data on OD after damage control strategy (DCS). Materials and Methods: A retrospective, observational cohort study was conducted through a complete revision of data of consecutive adult trauma patients (>18 years old) who underwent OD after DCS between January 2018 and May 2021. Four subgroups were created [Liver (Li), Lungs (Lu), Heart (H), Kidneys (K)] to compare variables between those who donated the organ of interest and those who did not. Results: Thirty-six patients underwent OD after DCS. Six patients (16.7%) were excluded: 2(5.6%) for missing data about admission; 4(11.1%) didn’t receive DCS. Mean ISS was 47.2 (SD ± 17.4). Number of donated organs was 113 with an organs/patient ratio of 3.8. The functional response rate was 91.2%. Ten organs (8.8%) had primary nonfunction after transplantation: 2/15 hearts (13.3%), 1/28 livers (3.6%), 4/53 kidneys (7.5%) and 3/5 pancreases (60%). No lung primary nonfunction were registered. Complete results of subgroup analysis are reported in supplementary materials. Conclusion: Organ donation should be considered a possible outcome in any trauma patient. Aggressive damage control strategy doesn’t affect the functional response rate of transplanted organs.

show abstract

Complications and Failure to Rescue After Abdominal Surgery for Trauma in Obese Patients

Cited by 5 publications

References 34 publications

The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

The impact of obesity on surgical outcomes in patients undergoing emergency laparotomy for high-risk abdominal emergencies

Impact of Excess Body Weight on Postsurgical Complications

Organ Donation after Damage Control Strategy in Trauma Patients: Experience from First Level Trauma Center in Italy

Contact Info

Product

Resources

About