Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity‐Matched Nationwide Cohort Study

Fu, Chih-Yuan; Bajani, Francesco; Bokhari, Marissa; Tatebe, Leah C; Starr, Frederic; Messer, Thomas; Kaminsky, Matthew; Dennis, Andrew; Schlanser, Victoria; Mis, Justin; Toor, Rubinder; Poulakidas, Stathis; Bokhari, Faran

doi:10.1007/s00268-019-05268-5

Cited by 16 publications

(11 citation statements)

References 41 publications

(44 reference statements)

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“…A high BMI is a well-established risk factor for noncommunicable diseases, such as cardiovascular disease or type 2 diabetes . However, its role in postoperative outcomes remains a topic of debate, with some studies suggesting that patients with a higher BMI are not at increased risk of detrimental postoperative outcomes, such as mortality or infection, while others suggest the opposite . In our study, an increase in BMI was associated with an increased risk of S aureus SSIs and BSIs.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Troeman,

Hazard,

Timbermont

et al. 2023

JAMA Netw Open

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ImportanceStaphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies.ObjectivesTo assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors.Design, Setting, and ParticipantsThis multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio.ExposurePreoperative S aureus colonization.Main Outcomes and MeasuresThe main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models.ResultsIn total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs.Conclusions and RelevanceIn this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.

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Section: Discussionmentioning

confidence: 99%

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Troeman,

Hazard,

Timbermont

et al. 2023

JAMA Netw Open

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“…No differences were found in non-operated victims. According to the authors, this indicates the need for alternative treatment tactics in obese victims [15].…”

Section: Discussionmentioning

confidence: 99%

Obesity Effect on the Course of Abdominal Trauma

et al. 2021

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The aim was to determine the role of obesity in the development of fatal complications and deaths in victims with abdominal trauma. Materials and methods: The study was conducted on the basis of the Department of Polytrauma at the Municipal Health Care Institution of Kharkiv City Council ”O.I. Meshchaninov City Clinical Hospital of Ambulance and Emergency Care”. The authors have analyzed the case histories of 240 patients with abdominal trauma depending on the presence of obesity, which was determined by BMI (body mass index) and/or waist circumference (WC). Results: Complications were found in 93 (38.8%) victims, 34 (14.2%) victims died. It was found that the overall incidence of complications, respiratory and hemocoagulation complications, the incidence of multiple organ failure (MOF) and mortality significantly increased in obese victims. Determination of obesity by the value of the BMI during hospitalization was possible in 41.7% of victims. The identification of WC turned out to be no less informative, but more accessible. Conclusions: Obesity increases the incidence of complications and mortality in victims of abdominal trauma, and is a marker of a negative prognosis. Traditional assessment of BMI during hospitalization in most victims with abdominal trauma is not possible due to the severity of the condition and/or the presence of combined injuries. A good alternative to determining obesity in victims with abdominal trauma is a WC (more than 88 cm in women and more than 102 cm in men).

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“…Obesity is associated with postoperative morbidity and mortality in patients undergoing abdominal surgery [13,14]. There is a significant increase in vascular, infectious and intraoperative complications after surgical interventions in this group [15].…”

Section: Introductionmentioning

confidence: 99%

The impact of obesity on postoperative complications and short-term survival after liver transplantation

Tejedor-Tejada¹,

García-Pajares²,

Safadi

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Background and aims Obesity is considered a risk factor for perioperative complications, but its effect on patients undergoing liver transplantation (LT) remains unclear. This study was conducted to analyze the impact of obesity on early morbidity and mortality risk following LT. Methods A multicenter study of outcomes in patients submitted to LT between 2009 and 2019 was conducted. Recipients were stratified into obese (BMI ≥ 30 kg/m2) and nonobese patients (BMI < 30 kg/m2). Early postoperative complications were compared and 30-day and 1-year patient and graft survival were assessed by Kaplan–Meier method. Primary graft nonfunction (PGNF) was defined as the presence of total bilirubin > 10 mg/dl, INR > 1.6 or ALT > 2000 U/l within the first week after LT. Results A total of 1608 patients were included after applying exclusion criteria, nonobese (1149, 71.46%) and obese patients (459, 28.54%). There were no significant differences in age, sex, Model for End-stage Liver Disease, Charlson comorbidity score, ethnicity, waiting list time and ischemia time. There were significantly higher rates of vascular (17.58% vs 23.53%, P = 0.021) and biliary complications (27.68% vs 35.73%, P = 0.006) and PGNF (11.40% vs 12.20%, P = 0.021) in obese patients. There was a significantly increased risk for long-term graft failure; however, there was no significant difference in patient survival after LT. Conclusion Obese patients have significantly increased morbidity in terms of vascular and biliary complications and PGNF after LT. They have a higher risk for worse 1-year graft survival in comparison to controls.

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Obesity is Associated with Worse Outcomes Among Abdominal Trauma Patients Undergoing Laparotomy: A Propensity‐Matched Nationwide Cohort Study

Cited by 16 publications

References 41 publications

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Obesity Effect on the Course of Abdominal Trauma

The impact of obesity on postoperative complications and short-term survival after liver transplantation

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