Risk and Predictors of Postoperative Mortality in Patients With Obesity Undergoing Trauma Laparotomy: A Systematic Review and Meta-Analysis With Meta-Regression

AimsTo evaluate the effect of obesity on postoperative mortality after trauma laparotomies.MethodsA PRISMA-compliant meta-analysis with meta-regression using random-effects modeling was conducted (last search: August 01, 2025). All studies comparing the risk of postoperative mortality in adult patients with and without obesity (BMI ≥30) undergoing trauma laparotomies were included. The certainty of evidence was evaluated using GRADE system.ResultsNine studies comprising 19,780 patients were included (obesity group: 6474; no obesity group: 13,306). The obesity and no obesity groups were comparable in terms of male sex (RD: -0.03, 95% CI -0.06, 0.00, <i>P</i> = .090), injury severity score (MD: 0.96, 95% CI -0.36, 2.29, <i>P</i> = .160), penetrating mechanism of injury (RD: -0.01, 95% CI -0.03, 0.00, <i>P</i> = .150), and blunt mechanism of injury (RD: 0.01, 95% CI -0.00, 0.03, <i>P</i> = .150). The patients in the obesity group were older (MD: 4.18 years; 95% CI 2.19, 6.18, <i>P</i> < .0001). The risk of postoperative mortality was higher in patients with obesity (OR: 1.33, 95% CI 1.09, 1.64. <i>P</i> = .006). Injury severity score (coefficient: 0.017, <i>P</i> = .004) and blunt mechanism (coefficient: 0.263, <i>P</i> = .017) were associated with an increased risk of mortality; penetrating mechanism (coefficient: -0.263, <i>P</i> = .017) was associated with a reduced risk of mortality; and age (coefficient: -0.004, <i>P</i> = .779) and male sex (coefficient: -0.055, <i>P</i> = .908) did not affect the mortality.ConclusionsObesity is associated with increased postoperative mortality in patients undergoing trauma laparotomies (moderate certainty). Injury severity score and blunt mechanism of injury may increase the risk of mortality in obese patients undergoing trauma laparotomies.