Obesity and Penetrating Trauma: Outcomes from a Level 1 Trauma Center in New York City

Abstract

Albert Yao,1,2 Jaiden I Busso,3 Nisha Lakhi1,4 1New York Medical College, School of Medicine, Valhalla, NY, USA; 2Maimonides Medical Center, Department of Pediatrics, Brooklyn, NY, USA; 3Boston University, Boston, MA, USA; 4Richmond University Medical Center, Department of Trauma Surgery, Staten Island, NY, USACorrespondence: Nisha Lakhi, Richmond University Medical Center Staten Island, Staten Island, NY, USA, Email [email protected]: Obesity is associated with increased morbidity and mortality in trauma scenarios; however, there has been conflicting evidence on outcomes of obesity and penetrating injuries, specifically gunshot wounds and stab wounds. We hypothesized that obesity may be protective due to a “cushioning effect” attributed to increased adiposity.Methods: This was a retrospective cohort study of patients presenting to a Level 1 Trauma Center with a penetrating trauma (gunshot/stab) injury during 2008– 2021. Patients with a BMI ≥ 30 were compared to those with a BMI < 30. The primary outcome was Injury Severity Score (ISS). Secondary outcomes included intensive care unit (ICU) length of stay, days on ventilation, length of hospital stay, service of admission (trauma surgery, general surgery, discharged home, general medical floor), the body region of injury(s), Abbreviated Injury Scale (AIS), OR requirement, type of surgery, and discharge status. Statistical analysis was performed using χ2-test or Fisher’s exact tests for categorical data, and Student’s t-test or Mann–Whitney U-test for continuous variables with p < 0.05 as statistically significant. Subgroup analysis was performed based on the mechanism of injury.Results: There were 721 patients that met inclusion criteria, of which 540 were classified in the non-obese group and 181 (25.1%) in the obese group. The primary outcome, mean ISS score, in obese patients (9.0, SD = 13.0) and non-obese patients (9.4, SD = 13.8) was similar between groups respectively. Secondary outcomes, which included rates of severe abdominal injury (AIS ≥ 3), rates of intra-abdominal organ injury, and rates of gastro-intestinal resection, were also similar between non-obese and obese patients.Conclusion: This study did not demonstrate the existence of a “cushioning effect” in the setting of penetrating traumatic injury. Patients with increased BMI had similar a ISS score and patterns of injury as their non-obese counterparts.Keywords: penetrating trauma, gun violence, obesity, cushioning effect

Keywords

• penetrating trauma
• gun violence
• obesity
• cushioning effect