title: Obesity delays functional recovery in trauma patients.
abstract: BACKGROUND
  Obesity is known to complicate trauma hospital stays. We hypothesize that obesity delays functional recovery in trauma patients.
  
  
  METHODS
  Between 2005 and 2007, adult patients with a hospital length of stay >24 h were prospectively recruited for the study. Functional Independence Measurement (FIM) scores were calculated at the time of admission, discharge, and 6 mo after discharge. Patients were classified as nonobese (body mass index [BMI] <25), overweight (BMI ≥25 and <30), obese (BMI ≥30 and <35), and morbidly obese (BMI ≥35). Multivariate analyses were performed to determine the impact of obesity on FIM scores.
  
  
  RESULTS
  Two hundred thirty-five patients met the study inclusion criteria. Average injury severity scores was >18. We recorded no mortality at the time of discharge and follow-up. During acute hospital stay stage, nonobese patients had an average of 24 points increase on FIM scores compared with morbidly obese patients with 16 points improvement (P = 0.023). Compared with nonobese patients, the rate of recovery was reduced by 30% in overweight (P = 0.034), 37% in obese (P = 0.025), and 48% in morbidly obese patients (P = 0.003). Alternatively, we found that for every unit increase in BMI, the functional recovery rate was reduced by 4% (P < 0.001). Changes in FIM scores during the postdischarge period were not significantly different by obesity classification, and all groups achieve similar functional outcome at follow-up (P = 0.482).
  
  
  CONCLUSIONS
  Most trauma patients achieve full functional recovery some time after hospital discharge, but the recovery is delayed in obese patients and the delay is directly correlated with the severity of obesity.
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Vinayak
authors.initials: V
authors.lastname: Dhungel
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.affiliation: Department of Internal Medicine, Community Regional Medical Center, Fresno, California.
authors.forename: Hrishikesh
authors.initials: H
authors.lastname: Raut
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Michele A
authors.initials: MA
authors.lastname: Lilienthal
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Garcia
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa.
authors.forename: Janelle
authors.initials: J
authors.lastname: Born
authors.affiliation: Department of Surgery, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa. Electronic address: kent-choi@uiowa.edu.
authors.forename: Kent C
authors.initials: KC
authors.lastname: Choi
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009767:Obesity, Morbid / Q000401:mortality*; D050177:Overweight / Q000401:mortality*; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000401:mortality* / Q000628:therapy*; D055815:Young Adult
keywords: BMI; Functional Independence Measurement; Morbidity; Mortality; Obesity; Trauma