Revisiting the Obesity Paradox in Burns: A Retrospective Cohort Study of Burn Patients Requiring Surgical Excision

Obesity represents a significant health burden in the United States and has a significant impact on individual health, increasing the likelihood of multiple comorbidities. However, the presence of an "obesity paradox", in which increasing body mass index (BMI) may be protective against morbidity and mortality in certain clinical settings, has been demonstrated in both trauma and emergency general surgery patients. The impact of obesity on outcomes in burn patients is mixed, and no study has evaluated the impact of obesity on burn outcomes specifically in patients requiring excision of burn wounds. We performed a retrospective cohort study utilizing the American Burn Association's Burn Care Quality Platform dataset, of burn patients requiring surgical excision. Primary outcome was the association of obesity with mortality. Secondary outcomes included association of obesity with infection, graft loss, ventilator days, and length of stay (LOS). Multivariate regressions, controlling for pertinent variables, were used for analysis. 6,045 patients were included in the analysis, 4,999 in the non-obese cohort and 1,046 in the obese cohort. There was no association between obesity and mortality, nor was there any association between obesity and graft loss. However, obesity was associated with increased odds for infection (OR 1.20, 95% CI 1.01 - 1.42, p = 0.04), increased ventilator days (IRR 1.34, 95% CI 1.19 - 1.51, p < 0.01), and an association in the direction of increased LOS (sHR 0.93, 95% CI 0.87 - 1.00, p = 0.06). Not only was there no obesity paradox, obesity was associated with increased morbidity in patients requiring excision.