Impact of obesity on outcomes after abdominal gunshot injury

Abstract

BACKGROUND:The impact of obesity, on outcomes after a gunshot wound, remains unclear. We hypothesized that patients with obesity have a higher burden of intraabdominal injuries after gunshot injury when compared with the nonobese population. METHODS:The Trauma Quality Improvement Program database (2013-2017) was queried for all patients age ≥16 with abdominal gunshot injuries. Patients who died in the emergency department (ED), arrived without signs of life, had Abbreviated Injury Scale score ≥ 3 in any other region, or transferred from an outside hospital were excluded. The patient with obesity was defined by a body mass index ≥ 30. Demographics, injury data, and outcomes were abstracted and analyzed. Patients with obesity were compared to those with a body mass index < 30. Multivariate logistical regression was used to compare mortality between groups. RESULTS: Of 34,138 patients with gunshot injuries, there were 2,616 (7.7%) with isolated abdominal injuries. Median age is 29 years (22-39 years), 86.7% men. Eight hundred twenty-seven (31.6%) were obese. The obese group was significantly older (32 [25-42] vs. 27 [22-37]; p < 0.001) with a higher incidence of hypertension (16.8% vs. 6.3%, p < 0.001) and diabetes mellitus (7.1% vs. 2.3%, p < 0.001). There was no difference in presenting vital signs, abdominal Abbreviated Injury Scale or Injury Severity Score between groups. The rate of superficial injuries and intraabdominal organ injuries were comparable between groups. Patients with obesity had significantly higher mortality (6.5% vs. 4.2%, p = 0.010), hospital length of stay (9 [7-16] vs. 9[6-14], p < 0.001), ventilator days (3 [2-5] vs. 3 [2-4], p = 0.015), and hospital-acquired pneumonia (3.5% vs. 1.7%, p = 0.005). On multivariate analysis, in addition to older age (odds ratio [OR], 1.050; p < 0.001), ED hypotension (OR, 3.192; p < 0.001), and ED tachycardia (OR, 3.714; p < 0.001), obesity was significantly associated with mortality (OR, 1.636; p = 0.021). CONCLUSION:Patients with obesity are at a high risk of mortality after abdominal gunshot injury. Further prospective evaluation is warranted.

“The armor phenomenon” in obese patients with penetrating thoracoabdominal injuries: A systematic review and meta-analysis

“…4 C ). One study noted obese patients to trend toward greater rates of developing acute renal failure, sepsis and pressure ulcers 25 …”

“…20,25 The risk of overlapping data existed between three studies due to interrogation of a database registry. 25,26,28 Controlling for confounders was only performed in four of nine studies. 20,22,26,28 Heterogeneity arose due to the energy of injury (stab vs. gunshot), level of acuity of the data source (level of trauma referral center), and local selective operative intervention protocols.…”

“…26 No description of the local protocol was provided in the remainder of studies. 22,[25][26][27] Pooled data from six studies demonstrated no significant difference in both nonsignificant injuries and successful nonoperative management in obese compared with nonobese patients sustaining stab injuries (Figs. 2A and B).…”

“…Five studies analyzed LOS following penetrating injury. 21,[23][24][25][26] There was no significant difference in overall LOS nor ICU LOS following stab injuries (Supplemental Digital Content SDC8, http://links.lww.com/TA/C365). However obese patients sustaining gunshot injuries spent a mean difference of one more day in hospital (MD, 0.99; 95% CI, 0.49-1.49; p = 0.0001; Fig.…”

“…com/TA/C362). [24][25][26] Within the pediatric population, obese children were less significantly less likely to undergo operative interventions (OR, 0.76; 95% CI, 0.66-0.87; p < 0.05) than those in the healthy weight group following penetrating thoracoabdominal injuries with no impact upon overall survival. 19…”