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Morbid Obesity’s Silver Lining: An Armor for Hollow Viscus in Blunt Abdominal Trauma

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Abstract

Background

Morbid obesity is usually accompanied by both subcutaneous and visceral fat accumulation. Fat can mimic an air bag, absorbing the force of a collision. We hypothesized that morbid obesity is mechanically protective for hollow viscus organs in blunt abdominal trauma (BAT).

Methods

The National Trauma Data Bank (NTDB) was queried for BAT patients from 2013 to 2015. We looked at the rate of gastrointestinal (GI) tract injuries in all BAT patients with different BMIs. A subset analysis of BAT patients with operative GI tract injuries was performed to evaluate the need for abdominal operation. Multivariate analyses were carried out to identify factors independently associated with increased GI tract injuries and associated abdominal operations.

Results

A total of 100,459 BAT patients were evaluated in the NTDB. Patients with GI tract injury had a lower proportion of morbidly obese patients [body weight index (BMI) ≥ 40 kg/m2)] (3.7% vs. 4.2%, p = 0.015) and instead had more underweight patients (BMI < 18.5) (5.9% vs. 5.0%, p < 0.001). The risk of GI tract injury decreased 11.6% independently in morbidly obese patients and increased 15.7% in underweight patients. Of the patients with GI tract injuries (N = 11,467), patients who needed a GI operation had a significantly lower proportion of morbidly obese patients (3.2% vs. 5.3%, p < 0.001). The risk of abdominal operation for GI tract injury decreased 57.3% independently in morbidly obese patients. Compared with underweight patients, morbidly obese patients had significantly less GI tract injury (6.0% vs. 13.3%, p < 0.001) and associated abdominal operation rates (65.2% vs. 73.3%, p < 0.001).

Conclusion

Obesity is protective in BAT. This translates into lower rates of GI tract injury and operation in morbidly obese patients. In contrast, underweight patients appear to suffer a higher rate of GI tract injury and associated GI operations.

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Authors and Affiliations

  1. Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Cook County Health and Hospital System and Rush University, 1950 West Polk Street, 8th floor, Chicago, IL, 60612, USA

    Chih-Yuan Fu, Francesco Bajani, Caroline Butler, Stanley Welsh, Thomas Messer, Matthew Kaminsky, Frederick Starr, Andrew Dennis, Victoria Schlanser, Justin Mis, Stathis Poulakidas & Faran Bokhari

  2. Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    Chih-Yuan Fu

Authors
  1. Chih-Yuan Fu
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  2. Francesco Bajani
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  3. Caroline Butler
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  4. Stanley Welsh
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  5. Thomas Messer
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  6. Matthew Kaminsky
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  7. Frederick Starr
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  8. Andrew Dennis
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  9. Victoria Schlanser
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  10. Justin Mis
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  11. Stathis Poulakidas
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  12. Faran Bokhari
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Contributions

Author contribution

Bokhari, Fu and Bajani contributed to study conception and design. Fu contributed to acquisition of data. Bokhari, Fu, Welsh, Bajani, Starr, Messer, Dennis, Kaminsky, Mis, Schlanser and Poulakidas analyzed and interpreted the data. Bokhari, Fu and Bajani drafted the manuscript. Bokhari, Fu and Bajani critically revised the manuscript.

Corresponding author

Correspondence to Faran Bokhari.

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The authors have no commercial associations or sources of support that might pose a conflict of interest.

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Fu, CY., Bajani, F., Butler, C. et al. Morbid Obesity’s Silver Lining: An Armor for Hollow Viscus in Blunt Abdominal Trauma. World J Surg 43, 1007–1013 (2019). https://doi.org/10.1007/s00268-018-4872-7

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  • DOI: https://doi.org/10.1007/s00268-018-4872-7

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