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
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Article info
Publication history
Published online: October 26, 2022
Accepted:
October 23,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
