Obesity in trauma: outcomes and disposition trends

Osborne, Zachary; Rowitz, Blair; Moore, Henry R.; Oliphant, Uretz J.; Butler, Joann; Olson, Michelle; Aucar, John A.

doi:10.1016/j.amjsurg.2013.10.013

Cited by 54 publications

(47 citation statements)

References 3 publications

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“…However, we found that within all populations (nonobese, obese, and morbidly obese), the number of physiological complications influenced ICU length of stay and number of procedures. In contrast to many researchers who investigated hospital resource usage as a single outcome (eg, total hospital length of stay, ICU length of stay), 3,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]30 we used canonical correlation analyses to examine the complex relationship between patient/injury characteristics and the multifaceted nature of hospital resources.…”

Section: Discussionmentioning

confidence: 99%

“…Categorical variables were analyzed by using 2 tests. BMI stratifications were grouped into 3 categories on the basis of previous research for multivariate analysis: nonobese, 3,[8][9][10]12,15,19,22,26 obese, and morbidly obese. 17,25,27,44 Analyses were completed on each weight classification.…”

Section: Discussionmentioning

confidence: 99%

“…29 In previous research on the effect of a patient's BMI on resource usage, each usage outcome was assessed independently of other resource usage variables. In those studies, 3,7,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]30 resource usage was evaluated as a secondary outcome by using familiar statistical analyses (t test, analysis of variance, regression analysis) suitable for the research questions. However, in order to best ascertain the association between the complex, multifaceted relationship of patient/ injury characteristics and hospital resource usage, the use of multivariate canonical correlation analyses is suggested.…”

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confidence: 99%

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Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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Background Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. Objectives To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. Methods A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. Results In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. Conclusions Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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“…Divergent results have added to the debate; in some studies obesity has been found to confer some protection after injury (22, 23), with no effect on mortality (24). Alternatively, other studies have found that obesity is an independent risk factor for complications including thromboembolism and death (25-29).…”

Section: Introductionmentioning

confidence: 99%

Obesity and clotting

Kornblith

Howard

Kunitake

et al. 2015

Journal of Trauma and Acute Care Surgery

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Structured Abstract Background Though obese patients have high thrombosis rates following injury, the role of obesity in coagulation after trauma remains unknown. We hypothesized that BMI is independently associated with increased measures of hypercoagulability longitudinally after injury. Methods Data were prospectively collected for 377 consecutive highest-level trauma activation patients with a body mass index (BMI) ≥ 18.5 kg/m2. Standard coagulation measures, citrated kaolin and functional fibrinogen thromboelastography (TEG), and clotting factors were measured at 0-120h. BMI categories were defined as normal weight (18.5-24.99 kg/m2), overweight (25-29.99 kg/m2), and obese (≥ 30 kg/m2). Results The 377 patients were mostly male (81%) and bluntly injured (61%), with median BMI of 25.8 kg/m2. 42% were normal weight (median BMI 22.5 kg/m2). There were no differences in age, gender, ISS or base deficit between groups. There were no differences in admission INR/PTT or factors II, V, VII, VIII, X, ATIII, or protein C. However, obese patients had higher admission platelet counts (303 vs. 269 × 109/L, p=0.004), lower D-dimer (1.88 vs. 4.00 ug/mL, p=0.004), and a trend toward higher factor IX (134 vs. 119 % activity, p=0.042) than normal weight patients. Measured by TEG, clot strength (MA) and functional fibrinogen level (FLEV) were also higher on admission for obese patients (MA 65.7 vs. 63.4 mm, p=0.016; FLEV 407 vs. 351 mg/dL, p=0.008). In multiple linear regression, the relationship of BMI to clot strength, FLEV, and FIX persisted through 24h. Similarly, the relationship of BMI and platelet count persisted through 120h (all p<0.05). In multiple logistic regression, for every 5kg/m2 increase in BMI, there was an 85% increase in odds of thromboembolic complication (OR 1.85, CI 1.13-3.08, p=0.017). Conclusion Obese trauma patients are hypercoagulable compared to their similarly-injured normal weight counterparts, which persists longitudinally after injury. The significance of this hypercoagulability requires elucidation for guidance of anticoagulation in this at-risk group. Level of Evidence Level III; prognostic

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“…Osborne et al evaluated outcomes in obese patients who suffered penetrating injury, fall injury, and motor vehicle collisions (MVC). 31 In this study, obese patients who were injured by falls and MVCs sustained fewer head injuries. The mortality rate was lowest in obese patients who had fall injury compared to the other two groups.…”

Section: The Effect Of Bmi In Injury Patterns and Recovery Timementioning

confidence: 97%