Obesity and outcomes in trauma - a systematic review and meta-analysis

Paul M Cromwell; Ian S Reynolds; Helen M Heneghan; Simon M Glasgow

doi:10.1016/j.injury.2022.10.026

Obesity and outcomes in trauma - a systematic review and meta-analysis

Injury. 2023 Feb;54(2):469-480. doi: 10.1016/j.injury.2022.10.026. Epub 2022 Oct 26.

Authors

Paul M Cromwell¹, Ian S Reynolds², Helen M Heneghan³, Simon M Glasgow⁴

Affiliations

¹ Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: paulcromwell@rcsi.ie.
² Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: reynoli@tcd.ie.
³ Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland. Electronic address: Helen.heneghan@svhg.ie.
⁴ Centre for Trauma Sciences, Blizard Institute of Cell and Molecular Biology, Queen Mary University of London, London, United Kingdom. Electronic address: s.glasgow@nhs.net.

PMID: 36323600
DOI: 10.1016/j.injury.2022.10.026

Abstract

Background: The physiological abnormalities relating to obesity and metabolic syndrome can contribute to worse outcomes following trauma especially in class 2 and 3 obesity. The aim of this systematic review was to determine whether patients with a higher class of obesity who suffer traumatic injury have a higher risk of worse outcomes including in-hospital mortality than normal-weight patients.

Methods: A systematic search of MEDLINE, EMBASE, CENTRAL, Web of Science and CINAHL was performed for studies that reported a comparison of in-hospital obesity-related outcomes against normal-weight individuals aged 15 years and older following trauma. Single or multiple injuries from either blunt and/or penetrating trauma were included. Burn-related injuries, isolated head injury and studies focusing on orthopaedic related perioperative complications were excluded.

Results: The search yielded 7405 articles; 26 were included in this systematic review. 945,511 patients had a BMI>30. A random-effects meta-analysis was performed for analysis of all four outcomes. Patients with class 3 obesity (BMI>40) have significantly higher odds of in-hospital mortality than normal-BMI individuals following blunt and penetrating trauma (OR, 1.75; 95% CI, 1.39-2.19, p=<0.00001), significantly longer hospital LOS (SMD, 0.23; 95% CI, 0.21-0.25; p<0.00001) and significantly longer ICU LOS (SMD, 0.19; 95% CI, 0.12-0.26; p<0.0001). In contrast, studies that examined blunt and penetrating trauma and classified obesity with a threshold of BMI>30 found no significant difference in the odds of in-hospital mortality (OR, 0.94; 95% CI, 0.86-1.02, p=0.13).

Conclusions: There is a higher risk of in-hospital mortality in patients living with class 3 obesity following trauma when compared with individuals with normal BMI. The management of patients with obesity is complex and trauma systems should develop specific weight related pathways to manage and anticipate the complications that arise in these patients. Systematic review registration number PROSPERO registration: CRD42021234482 Level of Evidence: Level 3.

Keywords: Body mass index; Obesity; Trauma; Trauma surgery; WHO obesity classes.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Body Mass Index
Humans
Obesity* / complications
Wounds, Penetrating*