The Obesity Paradox in Patients with Severe Soft Tissue Infections

Abstract 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 2006-2010 Nationwide Inpatient Sample was used to identify adult patients with SSTIs. Patients were categorized into non-obese and obese (non-morbid [BMI 30-39.9] and morbid [BMI > 40]). Logistic regression provided risk-adjusted association between obesity categories and in-hospital 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 non-obese patients (odds ratio [OR]=0.42, 95% confidence interval [CI] 0.25-0.70; p=0.001). Subanalysis revealed a similar trend, with lower odds of mortality in non-morbid obesity (OR=0.46, CI 0.23-0.91; p=0.025) and morbid obesity (OR=0.39, CI 0.19-0.80; p=0.011) groups. Conclusion Obesity is independently associated with reduced in-hospital mortality in patients with SSTI regardless of the obesity classification. This suggests that the obesity paradox exists in this acute surgical population.