Obesity May Not be Protective in Abdominal Stab Wounds.

CONTEXT: Current protocols for the management of abdominal stab wounds were established based on retrospective data from prior decades. Few have investigated whether higher body mass index (BMI) affects outcomes after these injuries. AIM: The aim was to determine the effects of obesity on outcomes in abdominal stab wound patients. SETTING AND DESIGN: This was a retrospective cohort study at a Level I university-associated trauma center in the United States. MATERIALS AND METHODS: We reviewed medical records of 100 adult patients admitted to our trauma center with abdominal stab wounds. Demographics, types of internal organ injury, gastrointestinal (GI) resection and repair, mortality, length of hospital stay (LOS), units of blood transfused within 24 h of admission, need and indications for exploratory laparotomy, surgical site infections (SSI), and need for re-operation were compared between obese and nonobese patients. STATISTICAL ANALYSIS: Categorical and continuous outcome variables were compared between the two groups using Chi-squared and independent-samples t-tests, respectively. BMI was evaluated as a predictor of outcomes using univariate and multivariate logistic regression. RESULTS: Records of 100 adult abdominal stab wound patients were reviewed. Twenty-five patients were obese. The obese group was older (38.76 vs. 31.23, P = 0.018). Rates of therapeutic laparotomy were similar between obese and nonobese patients (20 [80.00%] vs. 64 [85.33%]). Obesity was associated with longer LOS (9.6 vs. 6.5, P = 0.026). In the multivariate analysis, increasing BMI was an independent predictor of need for GI resection (odds ratio: 1.10 [1.02-1.18], P = 0.018). One patient from the obese group died. CONCLUSIONS: Obese patients with abdominal stab wounds have longer LOS than nonobese patients. Increasing BMI was an independent predictor of need for GI resection.

Dismal outcomes following damage control laparotomy in injured older adults, a cohort study.

BACKGROUND: The population of older adults is rapidly growing and more older patients are presenting with abdominal trauma. Outcomes have not been well defined for patients that require a damage control approach(DCL). METHODS: This was a retrospective study at a level one trauma center of patients age 65 years and older with abdominal trauma that required DCL. Outcomes reviewed included mortality, length of stay, discharge disposition. Presenting vital signs and laboratories were reviewed to identify predictors of mortality. RESULTS: 31 older patients(mean age 75.2 years) underwent DCL. Twenty-four of 31(77.4%) older patients died. Seven of 7 older DCL survivors were discharged to a rehabilitation center or nursing home. In comparisons of older DCL nonsurvivors and survivors there were not differences in presenting HR(90 versus 96; p = 0.56) or SBP in the emergency room(107 versus 116; p = 0.51). No differences in initial lactate or change in lactate concentration were found between nonsurvivors and survivors. Fifteen of 24 nonsurvivors died from multisystem organ failure. CONCLUSIONS/IMPLICATIONS: The mortality rate of older patients that require damage control approach for is extremely high. Presenting vital signs and laboratory markers may not be useful in older patients to predict mortality.