Obesity: Influence on Length of Hospital Stay for the Pediatric Burn Patient

Abstract

Childhood obesity is a major public health problem in the United States and is associated with numerous comorbidities. The relationship of obesity to risk of traumatic injury and recovery has been described, although not in depth. In adults with burns, obesity has been linked to negative impact on functional outcomes as well as increased mortality. Less is known about the impact of obesity on children with burns. The primary objective of this study was to determine the effect of obesity on length of hospital stay (LOS) among admitted pediatric burn patients. A secondary objective was to compare the difference in burn characteristics between obese and nonobese burn patients. To explore these questions, a retrospective cohort study of patients aged 0 to 18 years admitted to a children's hospital burn unit between February 1, 2000, and September 30, 2006 was performed. For the purposes of this study, obesity was defined as weight-for-length (<2 years of age) or body mass index (> or =2 years of age) > or =95th percentile for age and gender. Patients who had concomitant, nonburn injuries were not included in the study. LOS was measured in days, and an initial univariate analysis examined the association of clinical and demographic factors with LOS. To adjust for confounding, those factors that were found to be significantly associated with LOS were entered into a stepwise linear regression. A total of 528 patients were included in the study group, 17.4% of whom were obese. Obese patients were more likely to suffer a burn of a high-risk anatomic area (72.8% vs 60.8%). Median LOS for obese patients was significantly higher than nonobese (9.3 vs 7.1 days, P < .05). In the adjusted model, factors significantly associated with LOS included total body surface area burned, percent full thickness burn, Medicaid insurance status, and obesity. After controlling for these factors, obese children had a 6.5% longer LOS than nonobese children. This interesting finding raises the question of which factors are responsible for the increased length of stay for obese children hospitalized with burns. Investigating factors such as rate of complications, slower healing, or greater functional impairment may shed light on this finding.

Childhood obesity and in-hospital asthma resource utilization

“…[1][2][3] Recent studies have demonstrated worsened pediatric in-hospital outcomes, including mortality and increased resource utilization, for children with obesity across a range of diagnoses. [4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually.…”

Influence of body mass index on skin grafting in pediatric burns

“…Previous pediatric burn literature is conflicting when look at the effect of BMI ! 85th percentile on in-patient morbidity and mortality [15,16,19,20]. Our study revealed that pediatric obesity was not a risk factor for skin grafting.…”

“…There are many confounding variable that may influence wound healing and grafting that were not accounted for in this study including presence of infection during hospitalization and/or nutritional factors. While previous pediatric burn literature detected an increased overall length of stay, intensive care days, and mechanical ventilator days for obese children [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], these outcomes were not looked at in this study as the majority of children included in our study suffered from minor or moderates burns which may limit the ability to generalize our results to more severely burned patients.…”

Systematic review and meta-analysis of complications and outcomes of obese patients with burns

“…Such differences in response may be due to factors such as differences in body surface area, fat composition, reaction time and immunological response status. Regardless, studies that specifically discuss the mechanism of burns amongst overweight and obese paediatric patients as well as comparing and explaining differences in outcomes between obese adult and paediatric patients are lacking [34]. The management of the paediatric patient with burns can be different from that of an adult patient as well.…”