Risk Management and Healthcare Policy (Aug 2022)
Protective Role of Obesity on Trauma Impact: A Retrospective Analysis of Patients with Surgical Blunt Bowel Mesenteric Injury Due to Road Traffic Accidents
Abstract
Ting-Min Hsieh,1 Po-Chun Chuang,2 Chun-Ting Liu,3 Bei-Yu Wu,3 Yueh-Wei Liu,4,* Ching-Hua Hsieh5,* 1Division of Trauma, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Emergency, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 3Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 4Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 5Division of Plastic Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Yueh-Wei Liu; Ching-Hua Hsieh, Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Tel +886-7-7317123 ext. 8002 ; +886-7-7317123 ext. 8001, Email [email protected]; [email protected]: The “cushion effect” theory proposes that increased body mass index (BMI) is associated with less severe abdomen injury following blunt abdomen trauma, while the “obesity paradox” describes the protective effect of obesity against mortality. However, most previous studies used the abdominal abbreviated injury scale as the outcomes seemed to be inadequate owing to the injuries to the abdominal organs, such as the spleen and liver, which may be attributable to the force that caused the chest trauma. This study aimed to use adult trauma patients with surgical blunt bowel mesenteric injuries (BBMIs) to investigate the influence of obesity on the clinical outcomes and overall morbidities.Methods: This retrospective study reviewed the data of all hospitalized trauma patients between 2009 and 2019 and included all patients with surgically proven small bowel, colon, or mesenteric injuries due to a road traffic accident. Comparison of the outcomes was performed among 123 patients with surgically proven BBMI, who were categorized by BMI into the normal-weight (n = 73, BMI 30 kg/m2).Results: The obese group had a significantly lower incidence of isolated bowel injury (0%) compared with the normal-weight (35.6%) and overweight (16.2%) groups (p=0.005), but with higher incidence of isolated mesenteric injury or combined injury, although this was not significant. The obese group (92.3%) had a significantly higher percentage of overall morbidity than the normal-weight (61.6%) and overweight (70.3%) groups (p = 0.047). No significant difference was observed in the in-hospital mortality and 24-hour mortality among the three study groups.Conclusion: The study findings do not support the existence of a cushion effect and obesity paradox of obesity in blunt abdominal trauma.Keywords: obesity, trauma, blunt bowel mesenteric injury, mortality
