Low BMI (&lt; 10th percentile) increases complications and readmissions after posterior spinal fusion in adolescent idiopathic scoliosis

Farahani, Farzam; Riccio, Anthony I.; Ramo, Brandon

doi:10.1007/s43390-021-00353-z

Cited by 8 publications

(8 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…24 Another study showed increased adverse outcomes in adolescent patients with idiopathic scoliosis undergoing posterior spinal fusion including blood loss, pneumonia, and need for hospital readmission. 32 Regarding increased postoperative complication risk of obese and morbidly obese patients, a recent retrospective study using the National Readmission Database aligned with the results presented in our analysis. 22 This study showed that patients with a BMI of > 35 had increased odds of infection, wound dehiscence, and 30-day readmission while patients with a BMI > 40 were additionally at risk of renal failure.…”

Section: Discussionsupporting

confidence: 85%

Body Mass Index and Risk of Complications After Posterior Lumbar Spine Fusion: A Matched Cohort Analysis Investigating Underweight and Obese Patients

Alsoof

Johnson

McDonald

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

Objective: Previous studies have demonstrated that obesity is associated with increased complications after lumbar fusion. However, there are little published data on the effect of being underweight on lumbar fusion outcomes. The purpose of this study was to elucidate the effect of being underweight versus obese on outcomes after lumbar spinal fusion. Methods: Lumbar spinal fusion patients were identified through the PearlDiver Mariner database between 2010 and 2020. Study groups were created using International Classification of Diseases codes to identify preoperative body mass index (BMI) category as morbid obesity (BMI . 40), obesity (BMI 30 to 40), normal BMI (BMI 20 to 30), and underweight (BMI , 20) cohorts. Complications that occurred within 1 year postoperatively in this study and matched control groups were then isolated. Statistical analyses were conducted using the Pearson chi square method. Results: A total of 62,616 patients were identified in this analysis. This included 1,258 underweight patients (4.0%), 17,996 obese patients (57.5%), and 12,054 morbidly obese patients (38.5%). The number of patients to experience any postoperative complication was 766 (60.9%), 9,440 (52.4%), and 6,982 (57.9%) for the underweight, obese, and morbidly obese cohorts, respectively. Underweight patients showed an increased likelihood of complications related to instrumentation (odds ratio [OR] 1.85, P = 0.0237), revision fusion (OR 1.34, P = 0.04061), pulmonary complications (OR 1.43, P , 0.001), and sepsis (OR 1.91, P , 0.001). Obese patients with BMI 30 to 40 showed increased odds of the following complications: hemorrhages and hematomas (OR 1.20, P = 0.02634), surgical site complications (OR 1.27, P , 0.001), thromboembolism (OR 1.78, P , 0.001), and urinary complications (OR 1.08, P , 0.001). Morbidly obese patients with BMI . 40 showed increased odds of all complications analyzed in this study.

show abstract

Section: Discussionsupporting

confidence: 85%

Body Mass Index and Risk of Complications After Posterior Lumbar Spine Fusion: A Matched Cohort Analysis Investigating Underweight and Obese Patients

Alsoof

Johnson

McDonald

et al. 2022

J Am Acad Orthop Surg

View full text Add to dashboard Cite

show abstract

“…In the pediatric population, it has been demonstrated that children who are underweight or who have poor nutritional status as measured by low prealbumin levels have a higher risk of complications and poor wound healing after surgery. [30][31][32] In our study, the flap cohort had a higher percentage of patients who were underweight. Despite this, there was no increase in complication rates, suggesting that paraspinous flap coverage at the time of spine surgery mitigates additional risk in underweight pediatric patients.…”

Section: Discussionmentioning

confidence: 63%

Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries

Falade,

Park,

Conkling

et al. 2024

Ann Plast Surg

View full text Add to dashboard Cite

Purpose The benefits of paraspinous flaps in adult complex spine surgery patients are established in the literature; however, their use in pediatric patients has not been well described. This study compares clinical outcomes with and without paraspinous muscle flap closure in pediatric patients who have undergone spine surgery. Methods We conducted a retrospective review of all pediatric spine surgeries at the University of California, San Francisco from 2011 to 2022. Patients were divided into 2 cohorts based on whether the plastic surgery service closed or did not close the wound with paraspinous muscle flaps. We matched patients by age, American Society of Anesthesiology classification, prior spinal surgical history, and diagnosis. Surgical outcomes were compared between the 2 cohorts. Results We identified 226 pediatric patients who underwent at least one spinal surgery, 14 of whom received paraspinous flap closure by plastic surgery. They were matched in a 1:4 ratio with controls (n = 56) that did not have plastic surgery closure. The most common indication for plastic surgery involvement was perceived complexity of disease by the spine surgeon with concern for inadequate healthy tissue coverage (78.6%), followed by infection (21.4%). Postoperative complications were similar between the two groups. The plastic surgery cohort had a higher rate of patients who were underweight (57.1% vs 14.3%, P < 0.01) and had positive preoperative wound cultures (28.6% vs 8.9%, P = 0.05), as well as a higher rate of postoperative antibiotic usage (78.6 vs 17.9%, P < 0.01). There was no difference in recorded postoperative outcomes. Conclusions Spine surgeons requested paraspinous flap closure for patients with more complex disease, preoperative infections, history of chemotherapy, or if they were underweight. Patients with paraspinous flap coverage did not have increased postoperative complications despite their elevated risk profile. Our findings suggest that paraspinous muscle flaps should be considered in high-risk pediatric patients who undergo spine surgery.

show abstract

“…Previous studies have shown that BMI can affect short-term outcomes of posterior spinal fusion in pediatric patients. Farahani et al 23 found that low BMI is an independent predictor of blood loss, pneumonia and readmissions, while studies conducted by Katyal et al , 24 Malik et al 25 and Ramos et al 26 indicate that obese individuals have significantly higher rates of wound complications, infections and reoperations.…”

Section: Discussionmentioning

confidence: 99%

Plastic multilayered closure versus orthopedic surgeon closure after spinal instrumentation in pediatric neuromuscular scoliosis

Ezeokoli

Tamma

Borici

et al. 2023

World Jnl Ped Surgery

View full text Add to dashboard Cite

ObjectiveTo compare wound complication rates between orthopedic closure (OC) and plastic multilayered closure (PMC) in patients undergoing primary posterior spinal fusion for neuromuscular scoliosis (NMS). We hypothesize that multilayered closure will be associated with better postoperative outcomes.MethodsWe collected data on pediatric patients diagnosed with NMS who underwent first time spinal instrumentation between 1 January 2018 and 31 May 2021. Patient demographics, length of surgery, spinal levels fused and operative variables, wound complication rate, treatments, and need for wound washout were reviewed in depth and recorded.ResultsIn total, 86 patients were reviewed: 46 with OC and 40 with PMC. There was a significant increase in operating room (OR) time with PMC compared with OC (6.7±1.2 vs 7.3±1.3, p=0.016). There was no difference in complication rate, mean postoperative day of complication or unplanned return to the OR for OC and PMC, respectively. There was a slightly significant increase in the number of patients going home with a drain in the PMC cohort compared with the OC cohort (2.1% vs 15%, p=0.046).ConclusionsPMC demonstrated longer OR times than OC and did not demonstrate a statistically significant reduction in wound complications or unplanned returns to the OR. However, other studies have demonstrated statistical and clinical significance with these variables. Surgical programs should review internal patient volumes and outcomes for spinal fusion in NMS patients and consider if PMC after spinal fusions in pediatric patients with NMS or other scoliosis subtypes is an appropriate option in their institution to minimize postoperative wound complications.

show abstract

Low BMI (< 10th percentile) increases complications and readmissions after posterior spinal fusion in adolescent idiopathic scoliosis

Cited by 8 publications

References 25 publications

Body Mass Index and Risk of Complications After Posterior Lumbar Spine Fusion: A Matched Cohort Analysis Investigating Underweight and Obese Patients

Body Mass Index and Risk of Complications After Posterior Lumbar Spine Fusion: A Matched Cohort Analysis Investigating Underweight and Obese Patients

Paraspinous Muscle Flaps in Complex Pediatric Spine Surgeries

Plastic multilayered closure versus orthopedic surgeon closure after spinal instrumentation in pediatric neuromuscular scoliosis

Contact Info

Product

Resources

About