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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2021

01-10-2021 | Laparotomy | Original Article

Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy

Authors: Jose Covarrubias, Areg Grigorian, Sebastian Schubl, Sahil Gambhir, Matthew Dolich, Michael Lekawa, Ninh Nguyen, Jeffry Nahmias

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2021

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Abstract

Background

Patient-related risk factors for the development of postoperative pulmonary complications (PPCs) include age ≥ 60-years, congestive heart failure, hypoalbuminemia and smoking. The effect of obesity is unclear and has not been shown to independently increase the likelihood of PPCs in trauma patients undergoing trauma laparotomy. We hypothesized the likelihood of mortality and PPCs would increase as body mass index (BMI) increases in trauma patients undergoing trauma laparotomy.

Methods

The Trauma Quality Improvement Program (2010–2016) was queried to identify trauma patients ≥ 18-years-old undergoing trauma laparotomy within 6-h of presentation. A multivariable logistic regression analysis was used to determine the likelihood of PPCs and mortality when stratified by BMI.

Results

From 8,330 patients, 2,810 (33.7%) were overweight (25–29.9 kg/m2), 1444 (17.3%) obese (30–34.9 kg/m2), 580 (7.0%) severely obese (35–39.9 kg/m2), and 401 (4.8%) morbidly obese (≥ 40 kg/m2). After adjusting for covariates including age, injury severity score, chronic obstructive pulmonary disease, smoking, and rib/lung injury, the likelihood of PPCs increased with increasing BMI: overweight (OR = 1.37, CI 1.07–1.74, p = 0.012), obese (OR = 1.44, CI 1.08–1.92, p = 0.014), severely obese (OR = 2.20, CI 1.55–3.14, p < 0.001), morbidly obese (OR = 2.42, CI 1.67–3.51, p < 0.001), compared to those with normal BMI. In addition, the adjusted likelihood of mortality increased for the morbidly obese (OR = 2.60, CI 1.78–3.80, p < 0.001) compared to those with normal BMI.

Conclusion

Obese trauma patients undergoing emergent trauma laparotomy have a high likelihood for both PPCs and mortality, with morbidly obese trauma patients having the highest likelihood for both. This suggests obesity should be accounted for in risk prediction models of trauma patients undergoing laparotomy.
Appendix
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Metadata
Title
Obesity associated with increased postoperative pulmonary complications and mortality after trauma laparotomy
Authors
Jose Covarrubias
Areg Grigorian
Sebastian Schubl
Sahil Gambhir
Matthew Dolich
Michael Lekawa
Ninh Nguyen
Jeffry Nahmias
Publication date
01-10-2021
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-020-01329-w

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