Obesity and Outcomes After Surgery for Thoracoabdominal and Abdominal Gunshot Injuries

Overview

This retrospective observational study evaluated whether obesity was associated with outcomes after surgery for thoracoabdominal or isolated abdominal gunshot injuries. Adult patients who underwent surgery for these injuries at a referral trauma center between 2020 and 2025 were included. Patients were grouped according to body mass index, with obesity defined as a body mass index of 30 kg/m² or higher. Clinical characteristics, injury-related variables, perioperative findings, postoperative complications, need for reoperation, intensive care unit stay, mechanical ventilation, hospital stay, and mortality were evaluated. The study aimed to determine whether outcomes differed between patients with and without obesity and to identify factors associated with postoperative morbidity and mortality.

This was a single-center retrospective observational cohort study of adult patients who underwent surgery for thoracoabdominal or isolated abdominal gunshot injuries at a referral trauma center between 2020 and 2025. Patients aged 18 years or older were eligible for inclusion. Patients who died in the emergency department, arrived without signs of life, had an Abbreviated Injury Scale score of 3 or greater in another body region, or were transferred from another hospital were excluded. Patients were categorized according to obesity status. Obesity was defined as a body mass index of 30 kg/m² or higher, and outcomes were compared with those of patients with a body mass index below 30 kg/m². Data collected from medical records included demographic characteristics, injury-related variables, initial physiological and laboratory findings, perioperative characteristics, blood transfusion requirements, operative duration, gastrointestinal interventions, stoma creation, postoperative complications, need for reoperation, duration of mechanical ventilation, intensive care unit length of stay, total hospital length of stay, and mortality. The shock index was calculated as heart rate divided by systolic blood pressure at emergency department admission. Postoperative morbidity was defined as any postoperative complication with a Clavien-Dindo grade of IIIa or higher. Multivariable logistic regression analyses were used to evaluate factors independently associated with morbidity and mortality, with obesity included as the primary exposure variable.