Is Obesity Urban Body Armor? It is not as Protective as Thought for Abdominal Stab Wounds
*Vivian Hsiao1, *Jacob Sim2, *Asha Zimmerman2, *Andrew Stephen2
1Warren Alpert Medical School of Brown University, Providence, RI;2Department of Surgery, Alpert Medical School of Brown University, Providence, RI
Objective: To determine effects of obesity on outcomes in abdominal stab wound patients.Design: Retrospective cohortSetting: Level I University-Associated Trauma CenterPatients: Adult trauma patients admitted with abdominal stab wounds.Intervention: NoneMain Outcome Measure: Rates of therapeutic laparotomy, indications for exploratory laparotomy, visceral and solid organ injuries, gastrointestinal resection and repair, mortality, length of stay (LOS), blood transfusions within first 24h, surgical site infection, need for re-operation.Results: A chart review was conducted on 100 patients with abdominal stab wounds in the trauma registry. Twenty-five patients had a BMI≥30. The obese group was older (38.7 vs. 31.2, p=0.018) but the two groups were otherwise similar. Therapeutic laparotomy rates were also similar (non-obese 90.6%, obese 85%; p=0.4). Obesity was associated with longer LOS (9.6d vs. 6.5d; p=0.03). Multivariable logistic regression showed that increasing BMI independently predicts need for GI resection (OR 1.10, 95% CI 1.01-1.19). No differences were found in other outcome measures.Conclusions: Abdominal stab wounds were associated with longer LOS in obese patients, and increasing BMI was an independent predictor of need for GI resection. Otherwise, obese and non-obese patients have similar outcomes. Contrary to surgical adages, obesity appears non-protective. Future work will require larger sample sizes.
| BMI < 30 n = 75 | BMI ≥ 30 n = 25 | p | |
| Age | 31.23 (SD=13.62) | 38.76 (SD=13.49) | 0.018 |
| Male | 67 (89.3) | 21 (84) | 0.477 |
| BMI | 23.85 (SD=3.59) | 35.5 (SD=5.68) | 0.000 |
| Non-White | 45 (60.00) | 10 (40.00) | 0.082 |
| BMI < 30 n = 75 | BMI ≥ 30 n = 25 | p | |
| Exploratory Laparotomy | 64 (85.33) | 20 (80.00) | 0.538 |
| Peritonitis | 14 (21.88) | 5 (25.0) | 0.766 |
| Evisceration | 19 (26.69) | 6 (30.00) | 1.000 |
| Hemodynamic Instability | 9 (14.06) | 5 (25.0) | 0.305 |
| Imaging/DPL Finding | 11 (17.19) | 2 (10.0) | 0.724 |
| Concerning Exam | 8 (12.50) | 2 (10.0) | 1.000 |
| Therapeutic Laparotomy | 58 (90.62) | 18 (85.0) | 0.439 |
| Laparoscopy | 2 (2.67) | 0 (0.0) | 1.000 |
| DPL | 7 (9.3) | 0 (0.0) | 0.187 |
| Positive | 6 (8.0) | 0 (0.0) | 0.332 |
| GU Injury | 2 (2.7) | 0 (0.0) | 1.000 |
| Vascular Injury | 5 (6.7) | 1 (4.0) | 1.000 |
| Diaphragm Injury | 4 (5.3) | 1 (4.0) | 1.000 |
| Solid Organ Injury | 19 (25.3) | 7 (28.0) | 0.792 |
| Spleen Injury | 6 (8.0) | 2 (8.0) | 1.000 |
| Liver Injury | 12 (16.0) | 5 (20.00) | 0.759 |
| Kidney Injury | 1 (1.3) | 0 (0.00) | 1.000 |
| Traumatic Hernia Repair | 34 (45.3) | 9 (36.0) | 0.567 |
| Cholecystectomy | 1 (1.3) | 2 (8.0) | 0.153 |
| Mesenteric, omental appendage repair | 10 (13.3) | 2 (8.0) | 0.725 |
| GI Resection | 11 (14.7) | 6 (24.0) | 0.282 |
| GI Repair | 30 (40.0) | 9 (36.0) | 0.723 |
| Intraoperative Transfusions | 0.093 (SD=0.49) | 0 (SD=0.00) | 0.362 |
| # OR Visits | 1.10 (SD=0.49) | 1.35 (SD=1.25) | 0.171 |
| | BMI < 30 n = 75 | BMI≥30 n = 25 | p | |
| Died | 0 (0.00) | 1 (4.00) | 0.082 | |
| Blood 1st 24h (units) | 0.96 (3.43) | 0.28 (0.74) | 0.33 | |
| Length of Stay | 6.53 (3.76) | 9.6 (9.84) | 0.0257 | |
| Surgical Site Infection (SSI) | 6 (8.00) | 1 (4.00) | 0.497 | |
| Need for re-operation | 9 (12.00) | 3 (12.00) | 1.000 | |
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