Post-Procedure Outcomes of Obese Patients after Trauma Using a Large National Dataset

Ikenna Ifearulundu¹, John P Hunt^1,3, Patrick Greiffenstein^1,3, Alan Marr^1,3, Lance Stuke^1,3, Alison A Smith^1,3*

¹Louisiana State University Health and Sciences Center, Department of Surgery, USA
²Louisiana State University Health and Sciences Center, School of Medicine, USA
³University Medical Center New Orleans, USA

*Correspondence author: Alison A Smith, MD, PhD, FACS, Assistant Professor of Clinical Surgery, Louisiana State University, Department of Surgery, 2021 Perdido Street, Room 8143, New Orleans, LA 70112, USA;
Email: [email protected]

Citation: Ifearulundu I, et al. Post-Procedure Outcomes of Obese Patients after Trauma Using a Large National Dataset. J Surg Res Prac. 2025;6(2):1-7.

Copyright^© 2025 by Ifearulundu I, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Patient demographics, co-morbidities and risk factors for adult trauma patients undergoing procedures as stratified by weight class. Bold values are statistically significant.

Table 2: Clinical outcomes and discharge disposition for adult trauma patients undergoing procedures as stratified by weight class. Bold values are statistically significant.

Table 3: Binary multi-logistic regression of factors that could impact inpatient mortality for adult trauma patients.

Discussion

The global rise of the disease of obesity has extended to impacting outcomes for the trauma population, which is also a growing segment of patients worldwide. In this study, we found that underweight trauma patients had worse outcomes after undergoing a procedure during their hospital stay. While inpatient length of stay was longest in the class 3 obesity group, a multi-variate logistic regression analysis did not find obesity to be a significant risk factor for inpatient mortality for trauma patients undergoing an inpatient procedure. Thus, the results from this study did not find a clear association with elevated BMI and worse outcomes in trauma patients undergoing procedures.

Atkins and colleagues used the National Trauma Data Bank, which was the predecessor to the TQIP PUF, over a 9 year period (2013-2021) for blunt abdominal trauma [19]. The authors found that BMI may be protective against abdominal injury in isolated, blunt abdominal trauma. The authors also concluded that mortality did not decrease with increasing BMI which may be secondary to the higher incidence of co-morbidities in this patient population. In our study, we did not find any difference in mortality for patients with elevated BMI and certain co-morbidities. A significant age difference was found between the class 3 obesity group, which was younger than the other obesity groups and the underweight cohort which was the oldest. On multi-variate analysis, age was found to be a significant risk factor for inpatient mortality. This area merits further research to determine the impacts of age in the context of the “obesity paradox” for trauma patients undergoing in-hospital procedures following trauma.

Several prior studies demonstrated worse outcomes for obese patients with blunt chest trauma [10,16,17]. Choi and colleagues found that patients with morbid obesity were associated with longer hospital and ICU lengths of stay [10]. Similarly, Cone, et al., concluded that the obesity paradox did not extend to blunt chest trauma [16]. This study found that hospital length of stay was longer in trauma patients with class 3 obesity following procedures. However, inpatient mortality and discharge disposition were found to be worse in the underweight patient cohort, suggesting that this population is more vulnerable to a complicated hospital stay following interventions. In non-trauma patients undergoing emergency surgery, a previous study by Benjamin and colleagues using the ACS-NSQIP database found higher mortality in underweight patients, but significantly lower mortality in all obesity groups [6]. Interestingly, underweight and class 3 obesity were associated with increased complications and class 1 obesity was protective. The authors also concluded that underweight patients had worse morbidity and mortality following surgery, which was also consistent with our study findings. The observation of this “obesity paradox” in patients undergoing emergency general surgery procedures was similar to what we found for trauma patients undergoing procedures while hospitalized.

The differences in outcomes for underweight trauma patients undergoing procedures during their hospital admission is likely linked with poor nutrition at baseline prior to the trauma [5]. Several studies have demonstrated that patients with hypoalbuminemia prior to surgery have worse outcomes [21-23]. Due to the emergent nature of these procedures in the trauma population, there is often not a way to optimize the nutritional status of these patients prior to interventions [24]. This dilemma limits potential interventions to mitigate post-procedure complications in this high-risk population. Additional studies focused on this group could help to develop guidelines that specifically target underweight trauma patients who require inpatient procedures.

This study has several limitations which merit further discussion. While the data set used for this study represents a large national representation of trauma centers across the United States, not all trauma centers participate in TQP. This observation could limit the general applicability of these results to other trauma centers. In addition, the de-identified data set does not contain specific details on each study patient which could introduce some inherent bias as not all confounding variables could be evaluated. This data set is also retrospective which can also introduce an additional element of bias. The years evaluated for this study (2020 and 2022) spans the COVID-19 pandemic which could have impacted some of the trends observed. Despite these limitations, this is the first study to use the TQIP data to study this growing issue of obesity and quality outcomes in the trauma population following in-hospital procedures.

Conclusion

In conclusion, this study did not find a strong association in adult trauma patients between BMI class and in-hospital mortality after an in-hospital procedure. Underweight trauma patients had the worst outcomes. This finding could indicate that less than ideal body mass is a risk factor for fatal trauma outcomes. However, despite not having increased surgical complications, class 3 obesity patients remain hospitalized significantly longer than patients with normal BMI and are less likely to be discharged to their home compared to other patients with obesity, indicating that their recovery times are longer after undergoing similar trauma and similar procedures. Age was found to be a significant risk factor for inpatient mortality. It may be necessary to implement targeted post-procedure interventions to improve recovery for underweight trauma and class 3 obese patients.

Conflict of Interest

Dr. Smith is a paid consultant for Aroa Biologics and on the advisory board for Prytime Medical. The other authors declare no conflicts of interest.

Funding

There were no extramural sources of funding for this work.

Acknowledgments

The authors thank the American College of Surgeons Committee on Trauma for use of the Trauma Quality Improvement Data for this research. The authors would like to acknowledge Ms. Raediance Fuller for assistance with data collection.

Author Contributions

II: Data analysis, drafting of the manuscript; JPH: Critical revisions of the manuscript; PG: Critical revisions of the manuscript; AM: Critical revisions of the manuscript; LS: Critical revisions of the manuscript; AAS: Study design, data analysis, supervision, critical revisions of the manuscript.

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