The obesity paradox in patients with severe soft tissue infections

Journal article

Background The “obesity paradox” has been demonstrated in chronic diseases but not in acute surgery. We sought to determine whether obesity is associated with improved outcomes in patients with severe soft tissue infections (SSTIs). Methods The 2006 to 2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into nonobese and obese (nonmorbid [body mass index 30 to 39.9] and morbid [body mass index ≥ 40]). Logistic regression provided risk-adjusted association between obesity categories and inhospital mortality. Results There were 2,868 records with SSTI weighted to represent 14,080 patients. Obese patients were less likely to die in hospital than nonobese patients (odds ratio [OR] = .42; 95% confidence interval [CI], .25 to .70; P = .001). Subanalysis revealed a similar trend, with lower odds of mortality in nonmorbid obesity (OR = .46; 95% CI, .23 to .91; P = .025) and morbid obesity (OR = .39; 95% CI, .19 to .80; P = .011) groups. Conclusions Obesity is independently associated with reduced inhospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.

Authors: RIos-Diaz, A; Lin, E; Williams, K; Jiang, W; Patel, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: American Journal of Surgery
• Volume: 214
• Issue: 3
• Pages: 385-389
• Publication date: 2016-07-09
• Acceptance date: 2016-05-01
• DOI: 10.1016/j.amjsurg.2016.05.006
• ISSN: 1879-1883
• Keywords: Gas gangrene; Nutritional support; Obesity paradox; Sever soft tissue infections; Acute surgery; NSTI; Necrotizing fasciitis; Fournier's disease; Mortality