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Mild Obesity Is Protective After Severe Burn Injury

Jeschke, Marc G. MD, PhD*; Finnerty, Celeste C. PhD†,‡; Emdad, Fatemeh PhD; Rivero, Haidy G. MD; Kraft, Robert MD; Williams, Felicia N. MD; Gamelli, Richard L. MD§; Gibran, Nicole S. MD; Klein, Matthew B. MD; Arnoldo, Brett D. MD; Tompkins, Ronald G. MD**; Herndon, David N. MD

Annals of Surgery:
doi: 10.1097/SLA.0b013e3182984d19
Original Articles
Abstract

Objective: To assess the impact of obesity on morbidity and mortality in severely burned patients.

Background: Despite the increasing number of people with obesity, little is known about the impact of obesity on postburn outcomes.

Methods: A total of 405 patients were prospectively enrolled as part of the multicenter trial Inflammation and the Host Response to Injury Glue Grant with the following inclusion criteria: 0 to 89 years of age, admitted within 96 hours after injury, and more than 20% total body surface area burn requiring at least 1 surgical intervention. Body mass index was used in adult patients to stratify according to World Health Organization definitions: less than 18.5 (underweight), 18.5 to 29.9 (normal weight), 30 to 34.9 (obese I), 35 to 39.9 (obese II), and body mass index more than 40 (obese III). Pediatric patients (2 to ≤18 years of age) were stratified by using the Centers for Disease Control and Prevention and World Health Organization body mass index-for-age growth charts to obtain a percentile ranking and then grouped as underweight (<5th percentile), normal weight (5th percentile to <95th percentile), and obese (≥95th percentile). The primary outcome was mortality and secondary outcomes were clinical markers of patient recovery, for example, multiorgan function, infections, sepsis, and length of stay.

Results: A total of 273 patients had normal weight, 116 were obese, and 16 were underweight; underweight patients were excluded from the analyses because of insufficient patient numbers. There were no differences in primary and secondary outcomes when normal weight patients were compared with obese patients. Further stratification in pediatric and adult patients showed similar results. However, when adult patients were stratified in obesity categories, log-rank analysis showed improved survival in the obese I group and higher mortality in the obese III group compared with obese I group (P < 0.05).

Conclusions: Overall, obesity was not associated with increased morbidity and mortality. Subgroup analysis revealed that patients with mild obesity have the best survival, whereas morbidly obese patients have the highest mortality. (NCT00257244)

In Brief

The aim of this study is to determine the impact of obesity on postburn outcomes. We found that overall, obesity was not associated with increased morbidity and mortality. However, subgroup analysis revealed that patients with mild obesity have the best survival, whereas morbidly obese patients have the highest mortality.

Author Information

*Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, and Division of Plastic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

Shriners Hospitals for Children, and Department of Surgery, University of Texas Medical Branch, Galveston, TX

Sealy Center for Molecular Medicine and the Institute for Translational Science, University of Texas Medical Branch, Galveston, TX

§Department of Surgery, Loyola University Stritch School of Medicine, Maywood, IL

Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, WA

Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX; and

**Department of Surgery, Massachusetts General Hospital, Shriners Hospital for Children, and Harvard Medical School, Boston, MA.

Reprints: Marc G. Jeschke, MD, PhD, Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, and Division of Plastic Surgery, Department of Surgery, University of Toronto, Sunnybrook Research Institute, Rm D704, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. E-mail: marc.jeschke@sunnybrook.ca.

M.G.J. and C.C.F. contributed equally to this work.

The Inflammation and the Host Response to Injury Collaborative Research Program.

Disclosure: Supported in part by a Large Scale Collaborative Research Grant from the National Institute of General Medical Sciences (U54 GM-62119) awarded to Ronald G. Tompkins at the Massachusetts General Hospital, Boston, MA, and in part by research grants awarded to David N. Herndon at the University of Texas Medical Branch, Galveston, TX, by the National Institute of General Medical Sciences (P50 GM-60338, R01 GM-56687, T32 GM-008256), National Institute on Disability and Rehabilitation Research (H133A120091), and the Shriners Hospitals for Children (71008, 84080) and to Marc G. Jeschke by the Shriners Hospitals for Children (8660) and the National Institute of General Medical Sciences (R01 GM-087285). CCF is an Institute for Translational Sciences Career Development Scholar supported, in part, by NIH KL2RR029875 and NIH UL1RR029876. The authors declare no conflicts of interest.

© 2013 by Lippincott Williams & Wilkins.