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Tay-Lasso E, Grigorian A, Lekawa M, Dolich M, Schubl S, Barrios C, Nguyen N, Nahmias J. Obesity Does Not Increase Risk for Mortality in Severe Sepsis Trauma Patients. Am Surg 2023; 89:4734-4739. [PMID: 35236162 DOI: 10.1177/00031348221078986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The prevalence of obesity in the United States is up to 40% in adults. Obese patients with severe sepsis have a lower mortality rate compared with normal body mass index (BMI) patients. We hypothesized that trauma patients with severe sepsis and obese BMI will have a decreased mortality risk in comparison with normal BMI patients. METHODS The Trauma Quality Improvement Program (2017) was queried for adult trauma patients with documented BMI and severe sepsis. Patients were grouped based on BMI: non-obese trauma patients (nOTP) BMI <30 kg/m2 and obese trauma patients (OTP) ≥30 kg/m2. A multivariable logistic regression model was used for analysis of mortality. RESULTS From 1246 trauma patients with severe sepsis, 566 (42.4%) were nOTP and 680 (57.6%) were OTP. OTP had increased length of stay (LOS) (19 vs 21 days, P < .001), intensive care unit (ICU) LOS (13 vs 18 days, P < .001) and ventilator days (10 vs 11 days, P < .001). After adjusting for covariates, when compared to normal BMI patients, patients who were overweight (OR 1.11 CI .875-1.41 P = .390), obese (OR .797 CI .59-1.06 P = .126), severely obese (OR .926 CI .63-1.36 P = .696) and morbidly obese (OR 1.448 CI 1.01-2.07 P = .04) all had a similar associated risk for mortality compared to patients with normal BMI. CONCLUSION In adult trauma patients with severe sepsis, this national analysis demonstrated OTP had increased LOS, ICU LOS, and ventilator days compared to nOTP. However, patients with increasing degrees of obesity had similar associated risk of mortality compared to trauma patients with severe sepsis and a normal BMI.
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Affiliation(s)
- E Tay-Lasso
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - A Grigorian
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - M Lekawa
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - M Dolich
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - S Schubl
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - C Barrios
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - N Nguyen
- Department of Surgery, University of California, Irvine, Division of Gastrointestinal Surgery, Orange, CA, USA
| | - J Nahmias
- Department of Surgery, University of California, Irvine, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Volkova YV, Tsymbaliuk HV, Ponomaryova VV, Dmytriiev DV, Dmytriiev KD, Iievleva VI, Borodai IS. DYNAMICS OF INDICATORS IN PLATELET HEMOSTASIS IN POLYTRAUMA AND ENLARGED BODY MASS INDEX. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1285-1289. [PMID: 37364086 DOI: 10.36740/wlek202305223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
OBJECTIVE The aim: Analyze the dynamics of indicators in platelet hemostasis in polytrauma and enlarged body mass index. PATIENTS AND METHODS Materials and methods: A comprehensive study of hemostasis was performed in 224 sick with polytrauma and high body mass index within a month and on the 360th day. RESULTS Results: In Group I, the aggregation time was shortened during stimulation of ristomycin by 25% from day 1 to day 3. In patients in the II group, with the addition of ADP, the presence of hyperaggregation of platelets was determined from the 1st to the 3rd day and from the 30th to the 360th (a 36% reduction in time compared to the control was determined). In patients in the III group, ADP-aggregation was reduced on the 1st day (by 34%), after which hypoaggregation was noted (from the 3rd to the 14th and on the 360th day) with an increase in the rate of approximately 33% compared to the control group, after which there was a persistent hyperaggregation from 30 to 360 day with a 25% reduction in aggregation time. CONCLUSION Conclusions: An individual response of platelets to damage was established depending on the severity of polytrauma and increased body mass index.
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Affiliation(s)
| | | | - Valeria V Ponomaryova
- EDUCATIONAL AND SCIENTIFIC MEDICAL INSTITUTE OF THE NATIONAL TECHNICAL UNIVERSITY «KHARKIV POLYTECHNIC INSTITUTE», KHARKIV, UKRAINE
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Petrone P, Joseph DK, Baltazar G, Akerman M, Howell RS, Brathwaite CEM. Outcomes in Obese vs Non-Obese Injured Patients at a Level 1 Trauma Center and Bariatric Surgery Center of Excellence. Am Surg 2022:31348221083954. [PMID: 35343242 DOI: 10.1177/00031348221083954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We hypothesized that the outcomes of trauma patients with a body mass index (BMI) equal to or greater than 30 compared to patients with BMI less than 30 would not differ at a level 1 trauma center that is also a Metabolic and Bariatric Surgery Center of Excellence in the Metabolic and Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP). STUDY DESIGN Patients equal to and greater than 18 years old treated between 1/1/2018 and 12/31/2020 were included. Demographics, BMI, comorbidities, and outcomes (hospital-LOS, ICU-LOS, blood products used, and mortality) were compared between 2 groups: obese (BMI ≥30) vs non-obese (BMI <30). RESULTS Of the 4192 patients identified, 3821 met the inclusion criteria; 3019 patients had a BMI <30, and 802 had a BMI ≥30. There was a statistically significant difference between the 2 groups with respect to gender (females: 57% vs 47%, P < .0001) and age (median: 80 [IQR: 63-88] vs 69 [IQR: 55-81], P < .0001). When adjusted for age, sex, DM, dementia, ISS, and ICU admission, there was no statistically significant difference in hospital-LOS (4.30 [95% CI: 4.10, 4.52] vs 4.48 [95% CI: 4.18, 4.79]) or mortality. No statistical differences were seen between the 2 groups in blood product use. CONCLUSIONS Obesity did not correlate with poorer outcomes at an ACS-verified level 1 Trauma Center and Bariatric Surgery Center of Excellence. Further studies are needed to determine whether outcomes vary at hospitals without both designations.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - D'Andrea K Joseph
- Department of Surgery, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Gerard Baltazar
- Department of Surgery, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Meredith Akerman
- Department of Biostatistics, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Raelina S Howell
- Department of Surgery, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
| | - Collin E M Brathwaite
- Department of Surgery, NYU Long Island School of Medicine, 24998NYU Langone Hospital-Long Island, Mineola, NY, USA
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Oh MW, Valencia J, Moon TS. Anesthetic Considerations for the Trauma Patient with Obesity. CURRENT ANESTHESIOLOGY REPORTS 2022. [DOI: 10.1007/s40140-021-00508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Di Giacinto I, Guarnera M, Esposito C, Falcetta S, Cortese G, Pascarella G, Sorbello M, Cataldo R. Emergencies in obese patients: a narrative review. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8590435 DOI: 10.1186/s44158-021-00019-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.
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Drury B, Kocharians C, Dong F, Tran L, Beroukhim S, Hajjafar R, Vara R, Wong D, Woodward B, Neeki MM. Impact of Obesity on Mortality in Adult Trauma Patients. Cureus 2021; 13:e13352. [PMID: 33747653 PMCID: PMC7968702 DOI: 10.7759/cureus.13352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Trauma is a major cause of morbidity and mortality amongst all populations in the United States. With the widespread increase of obesity in the United States, studies have been conducted to compare different body mass index (BMI) groups and their clinical outcomes for traumatic injuries. The goal of this study was to retrospectively compare mortality between adult trauma patients with a high BMI to those with a lower BMI as well as investigate whether the mechanism of trauma had an effect on the outcome. Methods This study was a retrospective review of all adult trauma patients presented to the emergency department at Arrowhead Regional Medical Center (ARMC) between January 2014 and October 2019. The outcome was all-cause mortality. Patients were grouped according to BMI and mechanisms of injury, including blunt trauma, low velocity penetrating trauma, and high velocity penetrating trauma. Patients were also stratified by injury severity scores (ISS). Results Among the 9642 patients assessed in this study, majority (88%) of patients sustained blunt trauma. The number of patients among the three different BMI groups was appropriately equal with 34.4% of normal BMI, 34.6% overweight, and 31.1% obese. The overall mortality of all patients studied was 2.6% (n=248). There was no statistically significant difference in mortality among the three different BMI groups for blunt trauma, penetrating trauma, and subgroup analyses stratified by ISS score (ISS<16 or ISS ≥ 16). Conclusion Our study found no statistically significant differences in mortality among the three BMI groups in regard to mortality, even when stratified by ISS, or mechanism of injury, and traumatic velocities.
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Affiliation(s)
- Blake Drury
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Fanglong Dong
- Medicine, Western University of Health Sciences, Pomona, USA
| | - Louis Tran
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Reza Hajjafar
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Richard Vara
- Surgery, Arrowhead Regional Medical Center, Colton, USA
| | - David Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA.,Surgery, California University of Science and Medicine, San Bernardino, USA
| | - Brandon Woodward
- Surgery, Arrowhead Regional Medical Center, Colton, USA.,Surgery, California University of Science and Medicine, San Bernardino, USA
| | - Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA.,Emergency Medicine, California University of Science and Medicine, San Bernardino, USA
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Gihring A, Gärtner F, Liu C, Hoenicka M, Wabitsch M, Knippschild U, Xu P. Influence of Obesity on the Organization of the Extracellular Matrix and Satellite Cell Functions After Combined Muscle and Thorax Trauma in C57BL/6J Mice. Front Physiol 2020; 11:849. [PMID: 32848828 PMCID: PMC7399228 DOI: 10.3389/fphys.2020.00849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/24/2020] [Indexed: 12/13/2022] Open
Abstract
Obesity has been described as a major factor of health risk in modern society. Next to intricately linked comorbidities like coronary artery disease or diabetes, an influence of obesity on regeneration after muscle injury has been described previously. However, the influence of obesity on tissue regeneration in a combined trauma, merging the more systemic influence of a blunt lung trauma and the local blunt muscle trauma, has not been investigated yet. Therefore, the aim of this study was to investigate the influence of obesity on regeneration in a mouse model that combined both muscle and thorax trauma. Using gene expression analysis, a focus was put on the structure as well as the organization of the extracellular matrix and on functional satellite cell physiology. An increased amount of debris in the lung of obese mice compared to normal weight mice up to 192 h after combined trauma based on visual assessment can be reported which is accompanied by a decreased response of Mmp2 in obese mice. Additionally, a delayed and elongated response of inhibitor genes like Timp1 has been revealed in obese mice. This elongated response to the trauma in obese mice can also be seen in plasma based on increased levels of pro-inflammatory chemo- and cytokines (IL-6, MCP-1, and IL 23) 192 h post trauma. In addition to changes in the lung, morphological analysis of the injured extensor iliotibialis anticus of the left hind leg in lean and diet-induced obese mice revealed deposition of fat in the regenerating muscle in obese animals hindering the structure of a compact muscle. Additionally, decreased activation of satellite cells and changes in organization and build-up of the ECM could be detected, finally leading to a decreased stability of the regenerated muscle in obese mice. Both factors contribute to an attenuated response to the trauma by obese mice which is reflected by a statistically significant decrease in muscle force of obese mice compared to lean mice 192 h post trauma induction.
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Affiliation(s)
- Adrian Gihring
- Department of General and Visceral Surgery, Surgery Center, Ulm University Medical Center, Ulm, Germany
| | - Fabian Gärtner
- Department of General and Visceral Surgery, Surgery Center, Ulm University Medical Center, Ulm, Germany
| | - Congxing Liu
- Department of General and Visceral Surgery, Surgery Center, Ulm University Medical Center, Ulm, Germany
| | - Markus Hoenicka
- Department of Cardio-Thoracic and Vascular Surgery, Ulm University Medical Center, Ulm, Germany
| | - Martin Wabitsch
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics and Adolescent Medicine, Ulm University Medical Center, Ulm, Germany
| | - Uwe Knippschild
- Department of General and Visceral Surgery, Surgery Center, Ulm University Medical Center, Ulm, Germany
| | - Pengfei Xu
- Department of General and Visceral Surgery, Surgery Center, Ulm University Medical Center, Ulm, Germany
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