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

Published:January 05, 2023DOI:


      • 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.



      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.


      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.


      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.


      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.


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        • Hayes A.
        • et al.
        Modelling obesity trends in Australia: unravelling the past and predicting the future.
        Int J Obesity (Lond). 2017; 41: 178-185
      1. Australian Institute of Health and Welfare. Overweight and obesity. Determinants of Health 2022; Available from:

        • Ortega F.
        • Lavie C.
        • Blair S.
        Obesity and cardiovascular disease.
        Circ Res. 2016; 118: 1752-1770
        • Esser N.
        • et al.
        Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes.
        Diabetes Res Clin Pract. 2014; 105: 141-150
        • Praga M.
        • Morales E.
        The fatty kidney: obesity and renal disease.
        Nephron. 2017; 136: 273-276
        • Castle-Kirszbaum M.
        • et al.
        Obesity in neurosurgery: a narrative review of the literature.
        World Neurosurg. 2017; 2017: 790-805
        • Haynes J.
        • Nam D.
        • Barrack R.
        Obesity in total hip arthroplasty: does it make a difference?.
        Bone Joint J. 2017; (Jan(99-B)): 31-36
        • Yazhou H.
        • et al.
        BMI as a predictor for perioperative outcome of laparoscopic colorectal surgery: a pooled analysis of comparative studies.
        Dis Col Rec. 2017; 60: 433-445
        • Gray S.
        • Dieudonne B.
        Optimizing care for trauma patients with obesity.
        Cureus. 2018; 10
        • Dvorak J.
        • et al.
        The obesity paradox in the trauma patient: normal may not be better.
        World J Surg. 2020; 44: 1817-1823
        • Liu T.
        • et al.
        The effect of obesity on outcomes in trauma patients: a meta-analysis.
        Injury. 2013; 44: 1145-1152
        • Danne P.
        Trauma management in Australia and the tyranny of distance.
        World J Surg. 2003; 27: 385-389
      2. Australian Institute of Health and Welfare. Rural and remote health 2022; Available from:

        • Department of Health
        Changes in weight status of children and adults in Queensland and Australia: 2017-2018 prevalence and jurisdictional differences. Brisbane, 2019
        • World Health Organization
        Obesity: preventing and managing the global epidemic. World Health Organization, Geneva2000
        • Fu C.
        • et al.
        Morbid obesity's silver lining: an armor for hollow viscus in blunt abdominal trauma.
        World J Surg. 2019; 43: 1007-1013
        • Bochicchio G.
        • et al.
        Impact of obesity in the critically ill trauma patient: a prospective study.
        J Am Coll Surg. 2006;
        • Osborne Z.
        • et al.
        Obesity in trauma: outcomes and disposition trends.
        Am J Surg. 2014; 207: 387-392
        • Hatchimonji J.
        • et al.
        Obesity is associated with mortality and complications after trauma: a state-wide cohort study.
        J Surg Res. 2020; 247: 14-20
        • Serrano P.
        • Khuder A.
        • Fath J.
        Obesity as a risk factor for nosocomial infections in trauma patients.
        J Am Coll Surg. 2010; 211: 61-67
        • Glance L.
        • et al.
        Impact of obesity on mortality and complications in trauma patients.
        Ann. Surg. 2014; 259
        • Nasraway S.
        • et al.
        Morbid obesity is an independent determinant of death among surgical critically ill patients.
        Crit Care Med. 2006; 34: 964-970
        • Ciesla D.
        • et al.
        Obesity increases risk of organ failure after severe trauma.
        J Am Coll Surg. 2006; 203: 539-545
        • Brown C.
        • Velmahos G.
        The consequences of obesity on trauma, emergency surgery, and surgical critical care.
        World J Emerg Surg. 2006; 1
        • Moran S.
        • et al.
        Injury rates among restrained drivers in motor vehicle collisions: the role of body habitus.
        J Trauma. 2002; 52: 1116-1120
        • Brown C.
        • et al.
        The impact of obesity on the outcomes of 1,153 critically injured blunt trauma patients.
        J Trauma Acute Care Surg. 2005; 59: 1048-1051