Bariatric patients

In 2016, worldwide 13% of adults, (650 million) were obese1, however  New Zealand had  the 4rd highest prevalence of obesity in the world at 32.3%  (behind USA and Mexico and Chile)2.

Traditionally obesity has been defined as a BMI of >30 kg/m2, but recently redefined as “a chronic, relapsing, multifactorial, neurobehavioural disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical an psychosocial health consequences” 3.

Bariatric patients are more likely to fall, and to be involved in MVCs (daytime sleepiness from OSA). There is a tendency to different pattern of injuries, with more extremity and spinal injuries (especially during MVCs partially due to restraints being designed for lower BMIs). There is some protection from an abdominal “cushion effect” with reduced head injuries, abdominal blunt injuries (esp liver) and less peritoneal entry during penetrating injuries. Overall obesity was strongly associated with increase in injury severity score, hospital length of stay, intensive care unit admission, rate of pulmonary and general complications, multiorgan failure and mortality4.

Managing obese trauma patients can present specific challenges to the trauma provider and hospital system, but thier alterations to normal physiological can be predicted and adjusted for.

 

 

 

New Zealand is following the worldwide trend of increased rates of population obesity. Recent OCED figures estimate that 1 in 3 New Zealanders are obese, with the 3rd highest prevalence of obesity in the world (behind USA and Mexico)1

Managing obese trauma patients can present specific challenges to the trauma provider and hospital system.

Bariatric patients tend to have less severe injuries (according to scoring systems), but have a higher overall mortality (increased in hospital complications, longer ICU length of stay, increased ventilator days).2

Injury patterns can be different as well3

  • Increase in incidence of extremity, chest and pelvis injuries
  • Decrease in incidence of head and intraabdominal injures

 

Bariatric Table Single Page

 

 

References

    1. WHO (n.d.) Obesity and Overweight
    2. OECD (2017) Obesity update https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf
    1. The Obesity Medicine Association, (n.d.) What is Obesity https://obesitymedicine.org/what-is-obesity/
    1. Gray, S., & Dieudonne, B. (2018). Optimizing Care for Trauma Patients with Obesity. Cureus10(7), e3021. https://doi.org/10.7759/cureus.3021
    2. Greenberger, S., Werman, H. (2015) Obesity in Trauma Care https://www.reliasmedia.com/articles/31411-obesity-in-trauma-care

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Controversies – Guideline: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

About this guideline

Published: January 2018
Author: Emma Batistich
Updated: April 2021 (Sylvia Boys)
Approved by: Northern Region Trauma Network, ADHB, WDHB, CMDHB, NDHB, NRHL, St John
Review due: 2 years