Complications and Failure to Rescue After Abdominal Surgery for Trauma in Obese Patients. J Surg Res 2020 Jul;251:211-219
Date
03/15/2020Pubmed ID
32171135DOI
10.1016/j.jss.2020.01.026Scopus ID
2-s2.0-85081203319 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: Although obesity is considered an epidemic in the United States, there is mixed evidence regarding the impact of obesity on outcomes after traumatic injury and major surgery. We hypothesized that obese patients undergoing trauma laparotomy would be at increased risk of failure to rescue (FTR), defined as death after a complication.
METHODS: We analyzed trauma registry data for adult patients who underwent abdominal exploration for trauma at all 30 level I and II Pennsylvania trauma centers, 2011-2014. We used competing risks regression to identify significant risk factors for complications. We used multivariable logistic regression to identify significant risk factors for FTR.
RESULTS: Of 95,806 admitted patients, 15,253 (15.9%) were categorized as obese. Overall, 3228 (3.4%) underwent laparotomy, including 2681 (83.1%) nonobese and 547 (17.0%) obese patients. Among obese patients, 47.2% had at least one complication and 28.7% had two or more complications, compared with 33.5% and 18.7% of nonobese patients, respectively. The most common complication was pneumonia (15.0% of obese and 10.5% of nonobese patients; P = 0.003), followed by sepsis (8.8% versus 4.2%; P < 0.001) and deep vein thrombosis (8.4% versus 5.9%; P < 0.001). Obesity was independently associated with complications (hazard ratio, 1.4; 95% confidence interval, 1.2-1.6). In multivariable analysis, obesity was not associated with FTR (odds ratio, 1.3; 95% confidence interval, 0.9-2.0).
CONCLUSIONS: Obesity is a risk factor for complications after traumatic injury but not for FTR. The increased risk of complications may reflect processes of care that are not attuned to the needs of this population, offering opportunities for improvement in care.
Author List
Kaufman EJ, Hatchimonji JS, Ma LW, Passman J, Holena DNAuthor
Daniel N. Holena MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultFailure to Rescue, Health Care
Female
Humans
Laparotomy
Male
Middle Aged
Obesity
Pennsylvania
Postoperative Complications
Retrospective Studies
Wounds and Injuries
Young Adult
