Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications

Abstract

Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery (BS). Summary of Background Data. Obesity is an established risk factor for postoperative complications after spine surgery. BS has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing BS before spine surgery is associated with reduced adverse outcomes. Materials and Methods. PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. The search included indexed terms and text words from database inception to the date of the search (May 27, 2022). Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The primary outcome was an all-cause complication rate after surgery. Relative risks for surgical and medical complications were assessed. Results. A total of 4 studies comprising 177,273 patients were included. The pooled analysis demonstrated that the all-cause medical complication rate after spine surgery was lower in patients undergoing BS (relative risk: 0.54, 95% CI: 0.39, 0.74, P < 0.01). There was no difference in rates of surgical complications and 30-day hospital readmission rates between the cohort undergoing BS before spine surgery and the cohort that did not. Conclusion. These analyses suggest that obese patients undergoing BS before spine surgery have significantly lower adverse event rates. Future prospective studies are needed to corroborate these findings. Level of Evidence. 4.

Obesity in the Patient Undergoing Spinal Surgery: Preoperative, Intraoperative, and Postoperative Management Considerations for Patient Optimization

“…Multiple studies have also shown that bariatric surgery can reduce the risk for medical complications after spine surgery. [21][22][23][24] Jain et al 21 used a retrospective cohort study of 590 patients who had undergone bariatric surgery before lumbar fusion to show this difference, but noted these patients still had increased risk for complications, infections, and reoperation when compared with nonobese patients. Recently, Gupta et al 23 redemonstrated this reduced risk of postoperative medical complications, but noted no reduction in surgical complications or 30-day readmission rates in their meta-analysis.…”

“…[21][22][23][24] Jain et al 21 used a retrospective cohort study of 590 patients who had undergone bariatric surgery before lumbar fusion to show this difference, but noted these patients still had increased risk for complications, infections, and reoperation when compared with nonobese patients. Recently, Gupta et al 23 redemonstrated this reduced risk of postoperative medical complications, but noted no reduction in surgical complications or 30-day readmission rates in their meta-analysis. Therefore, it is clear that although bariatric surgery shows promising benefits, it does not entirely mitigate the risk of postoperative complications in these patients.…”

“…Multiple studies have also shown that bariatric surgery can reduce the risk for medical complications after spine surgery 21–24. Jain et al21 used a retrospective cohort study of 590 patients who had undergone bariatric surgery before lumbar fusion to show this difference, but noted these patients still had increased risk for complications, infections, and reoperation when compared with nonobese patients.…”