Association of Obesity With Respiratory Complications in Trauma Patients Undergoing Emergent Surgery

J Surg Res. 2026 Jun:322:298-304. doi: 10.1016/j.jss.2026.03.076. Epub 2026 Apr 16.

Abstract

Introduction: Obesity has been linked to increased mortality and respiratory complications following trauma. However, the association between obesity and respiratory complications in trauma patients undergoing emergent surgery remains unclear. Given the altered respiratory mechanics and airway management difficulties in obese patients, we hypothesized that obesity would be associated with increased respiratory complications and mortality in trauma patients requiring emergent surgery.

Methods: The Trauma-Quality-Improvement-Program database (2017-2022) was queried for trauma patients ≥18-y-old undergoing emergency surgery. Emergency surgery was defined as undergoing an operation within 2 h of arrival. Patients were categorized as obese (BMI ≥30) or non-obese (BMI <30). The primary outcome was respiratory complications, defined as unplanned intubation, ventilator-associated pneumonia, and/or acute respiratory distress syndrome. Bivariate and multivariable logistic regression analyses were performed.

Results: From 240,120 patients, 75,386 (31.4%) were obese. Obese patients had a lower rate of lung injuries (17.0% versus 18.8%, P < 0.001) but higher rates of respiratory complications (3.9% versus 2.7%, P < 0.001) and mortality (4.2% versus 3.6%, P < 0.001). After adjusting for covariates, the associated risk of respiratory complications (OR 1.43, CI 1.36-1.51, P < 0.001) and mortality (OR 1.11, CI 1.05-1.17, P < 0.001) were higher for obese patients.

Conclusions: Despite lower rates of lung injuries, obese patients had an increased associated risk of respiratory complications and mortality. Obesity is linked to physiological changes, such as impaired airway management and ventilation, which increase the risk of respiratory issues. These findings highlight the need to include obesity in risk prediction models for trauma patients requiring emergent surgery.

Keywords: Emergent surgery; Mortality; Obesity; Respiratory complications; Trauma.

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity* / complications
  • Pneumonia, Ventilator-Associated* / epidemiology
  • Pneumonia, Ventilator-Associated* / etiology
  • Postoperative Complications* / epidemiology
  • Postoperative Complications* / etiology
  • Respiratory Distress Syndrome* / epidemiology
  • Respiratory Distress Syndrome* / etiology
  • Retrospective Studies
  • Risk Factors
  • Wounds and Injuries* / complications
  • Wounds and Injuries* / mortality
  • Wounds and Injuries* / surgery
  • Young Adult