Examining Obesity and Its Association With Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation Study

Edward J Kelly; Adam D Reese; Bonnie C Carney; John W Keyloun; Tina L Palmieri; Lauren T Moffatt; Jeffrey W Shupp; Shawn Tejiram

doi:10.1016/j.jss.2023.05.005

Examining Obesity and Its Association With Burn Injury: A Secondary Analysis of the Transfusion Requirement in Burn Care Evaluation Study

J Surg Res. 2023 Oct:290:221-231. doi: 10.1016/j.jss.2023.05.005. Epub 2023 Jun 6.

Authors

Edward J Kelly¹, Adam D Reese¹, Bonnie C Carney², John W Keyloun¹, Tina L Palmieri³, Lauren T Moffatt², Jeffrey W Shupp⁴, Shawn Tejiram⁵

Affiliations

¹ The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia.
² Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
³ Department of Surgery, Burn Division, University of California, Sacramento, California.
⁴ The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia.
⁵ The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia; Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia; Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia. Electronic address: shawn.tejiram@medstar.net.

PMID: 37285704
DOI: 10.1016/j.jss.2023.05.005

Abstract

Introduction: Literature examining the connection between obesity and burn injuries is limited. This study is a secondary analysis of a multicenter trial data set to investigate the association between burn outcomes and obesity following severe burn injury.

Materials and methods: Body mass index (BMI) was used to stratify patients as normal weight (NW; BMI 18.5-25), all obese (AO; any BMI>30), obese I (OI; BMI 30-34.9), obese II (OII; BMI 35-39.9), or obese III (OIII; BMI>40). The primary outcome examined was mortality. Secondary outcomes included hospital length of stay (LOS), number of transfusions, injury scores, infection occurrences, number of operations, ventilator days, intensive care unit LOS, and days to wound healing.

Results: Of 335 patients included for study, 130 were obese. Median total body surface area (TBSA) was 31%, 77 patients (23%) had inhalation injury and 41 patients died. Inhalation injury was higher in OIII than NW (42.1% versus 20%, P = 0.03). Blood stream infections (BSI) were higher in OI versus NW (0.72 versus 0.33, P = 0.03). Total operations, ventilator days, days to wound healing, multiorgan dysfunction score, Acute Physiology and Chronic Health Evaluationscore, hospital LOS, and intensive care unit LOS were not significantly affected by BMI classification. Mortality was not significantly different between obesity groups. Kaplan-Meier survival curves did not significantly differ between the groups (χ² = 0.025, P = 0.87). Multiple logistic regression identified age, TBSA, and full thickness burn as significant independent predictors (P < 0.05) of mortality; however, BMI classification itself was not predictive of mortality.

Conclusions: No significant association between obesity and mortality was seen after burn injury. Age, TBSA, and percent full- thickness burn were independent predictors of mortality after burn injury, while BMI classification was not.

Keywords: Body mass index; Burn injury; Mortality; Obesity; Survival; TRIBE.

Publication types

Multicenter Study

MeSH terms

Blood Transfusion
Burns* / complications
Burns* / therapy
Humans
Length of Stay
Obesity / complications
Obesity / epidemiology
Obesity / therapy
Organ Dysfunction Scores
Retrospective Studies
Sepsis* / complications