S. Gammill1, J. Stover1, S. Knowles1, A. Marr1, J. Duchesne2, J.P. Hunt1, L. Stuke1, P. Greiffenstein1, A. Smith1 1Louisiana State University Health Sciences Center, New Orleans, LA, USA 2Tulane University School Of Medicine, New Orleans, LA, USA
Introduction: Outcomes in obese trauma patients undergoing damage control laparotomy has not been well-studied. Our aim was to determine if injury severity score (ISS) impacts outcomes for obese trauma patients undergoing damage control laparotomy.
Methods: A retrospective review of adult trauma patients undergoing damage control laparotomy who presented to a Level 1 trauma center over a nine-year period. Patient demographics, Body Mass Index (BMI), ISS, and complications were recorded. Patients were stratified by ISS < 25 or > 25 and divided into cohorts based on BMI. Univariate and multivariate analysis were performed.
Results: A total of 31,718 trauma patients were reviewed and 266 met inclusion criteria: 92 patients with BMI < 25 (34.6%), 79 overweight patients (BMI 25-30, 29.7%), and 95 obese patients (BMI > 30, 35.7%). BMI, ISS, and age were found to have a higher odd ratio (OR) of mortality (OR BMI = 1.074, CI: 1.022 – 1.13, OR ISS 1.046, CI :1.018 – 1.076, and Age OR 1.031, CI: 1.008 – 1.056). OTP with an ISS >25 had lower rates of penetrating trauma (54% v 74%, p<0.001) and no significant differences in outcomes compared to patients with normal BMI. OTP with an ISS < 25 had higher rates of inability to close fascia (72% obese vs 80% overweight vs. 94% normal; p = 0.0113) and mortality (35.3% obese vs 17.6% overweight vs 6.1% normal BMI; p = 0.03).
Conclusion: This study is the largest to date that investigated abdominal closure in obese trauma patients undergoing damage control laparotomy. Obese trauma patients with less severe ISS were found to have greater difficulty with abdominal closure compared to more injured patients. Future prospective studies are needed to evaluate this phenomenon.