title: Impact of obesity in damage control laparotomy patients.
abstract: BACKGROUND
  Obesity is an independent predictor of increased morbidity and mortality in critically injured trauma patients. We hypothesized that obese patients in need of damage control laparotomy (DCL) will encounter an increase incidence of postsurgical complications with a concomitant increase mortality when compared with a cohort of nonobese patients.
  
  
  METHODS
  All adult trauma patients who underwent DCL during a 4-year period at a Level I Trauma Center were retrospectively reviewed. Patients were categorized into nonobese (body mass index [BMI] < or = 29 kg/m), obese (BMI 30-39 kg/m), and severely obese (BMI > or = 40 kg/m) groups. Outcome measures included the occurrence of postoperative infectious complications, failure of primary abdominal wall fascial closure, acute respiratory distress syndrome, acute renal insufficiency, multiple system organ failure, days of ventilator support, hospital length of stay, and death.
  
  
  RESULTS
  During a 4-year period, 12,759 adult trauma patients were admitted to our Level I Trauma Center of which 1,812 (14.2%) underwent emergent laparotomy. Of these, 104 (5.7%) were treated with DCL: nonobese, n = 51 (49%); obese, n = 38 (37%); and severely obese, n = 15 (14%). In a multivariate adjusted model, multiple system organ failure was 1.82 times more likely in severely obese (95% CI: 1.14-2.90) and 1.74 times more likely in the obese patients (95% CI: 1.14-2.66) when compared with patients with normal BMI after DCL (p < 0.01). In the severely obese patients undergoing DCL, significantly elevated prevalence ratios (PR) for development of postoperative infectious complications, acute renal insufficiency, and failure of primary abdominal wall fascial closure were 1.75, 3.07, and 2.62, respectively. Days of ventilator support, length of stay, and mortality rates were significantly higher in severely obese patients (24 days, 27 days, and 60%) compared with obese (14 days, 14 days, and 21%) and nonobese (9.8 days, 14 days, and 28%) patients.
  
  
  CONCLUSIONS
  Severe obesity was significantly associated with adverse outcomes and increased resource utilization in trauma patients treated with DCL. Measures to improve outcomes in this vulnerable patient population must be directed at multiple levels of health care.
authors: Section of Trauma and Critical Care Surgery, Department of Surgery and Anesthesia, Tulane University School of Medicine, New Orleans, Louisiana 70112-2699, USA. jduchesn@tulane.edu
authors: Juan C
authors: JC
authors: Duchesne
authors: Robert E
authors: RE
authors: Schmieg
authors: Jon D
authors: JD
authors: Simmons
authors: Tareq
authors: T
authors: Islam
authors: Clifton L
authors: CL
authors: McGinness
authors: Norman E
authors: NE
authors: McSwain
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D015996:Survival Rate; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology