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Outcomes of the overweight and obese major trauma patient in the rural setting

Published:January 05, 2023DOI:https://doi.org/10.1016/j.injury.2023.01.021

      Highlights

      • The majority of major trauma patients treated at our regional community are overweight or obese. Understanding the challenges involved in management of these patients is important.
      • No mortality differences were detected in this patient cohort.
      • In obese patients, those with the highest BMI are more likely to require a longer hospital and ICU admission, and suffer from complications including sepsis, acute kidney injury, fluid overload and pneumonia.

      Abstract

      Purpose

      Overweight and obese patients are more prevalent in rural and remote areas and are of major public health concern in Australia. We aimed to evaluate the mortality and morbidity of overweight and obese trauma patients in the rural Australian context.

      Method

      This was a retrospective cohort study on 207 major trauma patients (injury severity score [ISS] > 12) treated at the Mackay Base Hospital between 2018 and 2021. Data was extracted from the Mackay Base Hospital trauma database and hospital records. Outcomes were compared between body mass index (BMI) groups.

      Results

      There were 164 males (79%) and 43 females (21%). The average BMI was 27.09 (standard deviation 5.46). 7 patients (3%) were in the underweight category (BMI < 18.5 kg/m2), 70 (34%) were of normal weight (BMI 18.5–24.9 kg/m2), 79 (38%) were overweight (BMI 25–29.9 kg/m2), and 51 (25%) were obese (BMI > 30 kg/m2). The majority of trauma was blunt (n = 203, 98%). Compared to patients with normal BMI, obese patients were significantly more likely to require intubation, intensive care unit (ICU) admission, and have a longer ICU stay. There were no significant differences in requirement for surgery, duration of surgery, hospital length of stay, ventilator time, or mortality (P > 0.05). However, subgroup analysis of the obese patient group showed an increased rate of complications (sepsis, acute kidney injury, fluid overload and pneumonia), longer ventilation times, hospital and ICU length of stay with increasing BMI in these patients.

      Conclusion

      The majority of trauma presentations in our regional community are in overweight or obese patients. Overweight and obese patients are more likely to require intubation and have a longer intensive care unit admission than normal weight counterparts. Amongst obese patients, those with BMI > 40 (obesity class 3) are at significantly increased risk of complications.

      Keywords

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