Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Abdallah, Dima Y.; Jadaan, Mutaz; McCabe, John P.

doi:10.1007/s00586-013-2890-6

Cited by 105 publications

(67 citation statements)

References 70 publications

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“…1,3,14,29 These findings may be attributable to patient positioning, soft-tissue dissection, and inefficient or absent specialized equipment to enable expedient surgical intervention. With respect to hospital stay, it is plausible that the higher prevalence of comorbid conditions seen in the obese group-for example, obstructive airway disease, hypertension, diabetes mellitus, and coronary artery disease-may complicate recovery and consequentially extend the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have described a strong association between BMI and SSI. 1,13,20,27 Interestingly, a handful of others have equally disagreed with this association. 15,22,30,32 Buerba et al 3 suggested that a BMI threshold ≥ 40 kg/m 2 may be more of a risk factor for SSI than all BMIs > 30 kg/m 2 .…”

Section: Discussionmentioning

confidence: 99%

“…12,25,26,31 Systematic reviews have identified obesity as an independent risk factor for increased blood loss, prolonged operating time, and more frequent complications with lumbar fusion surgery. 1,10,14 While most studies have revealed either a higher complication rate or increased resource utilization, inferior clinical outcomes in obese patients have not been consistently demonstrated. 14,28 Despite the current lack of evidence, a tendency to favor less extensive, nonfusion procedures in obese patients is plausible given the historically higher postoperative complication rates associated with these patients.…”

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confidence: 99%

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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“…Diyabetik yaralarda hipoksi ve hiperglisemi reaktif oksijen radikalleri antioksidan düzeyi aştığında serbest radikal salını-mıyla oksidatif strese neden olarak sürecin uzamasına ve biyofilm oluşumuna katkı sağlar (8,9). Kontrolsüz diyabette hiperglisemi, hücresel ve humoral immün yanıtı bozarak yarada hücresel disfonksiyona neden olur (10,11). Bakteriler tarafından "quorum sensing" (QS) sinyal molekülleri aracılığıyla üretilen virülans faktörleri polimorfonükleer lökositlerin fagositik aktivitesine karşı koruyucu rol oynar.…”

Section: Introductionunclassified

Biofilm and Diabetic Foot Infections

Vatan¹,

Saltoğlu²

2017

Klimik Dergisi

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Biofilm is a well known issue with increasing importance, especially in the field of medicine. The biofilm formation is usually observed in foreign body infections as well as chronic wound infections. The diabetic foot ulcer is suitable for biofilm formation due to its rich wound exudate and debris content and impaired host immune response. The diabetic foot infection has emerged as one of the most important causes of mortality and morbidity in diabetes mellitus which needs special efforts to eradicate infection due to high rate of biofilm formation. In this review, we discuss the characteristic features of biofilms and the importance of the biofilm formation in diabetic foot infections. We also highlight the diagnosis and management of the biofilm formation.

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The objective of this meta-analysis by Abdallah et al [1] was to synthesize evidence from studies that evaluated the association between body mass index and risk of surgical site infection following spine surgery. It is an interesting study.

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mentioning

confidence: 99%

Comment on Abdallah et al. entitled “Body mass index and risk of surgical site infection following spine surgery: a meta-analysis”

Tian

Zhang

Guo³

et al. 2013

Eur Spine J

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The objective of this meta-analysis by Abdallah et al. [1] was to synthesize evidence from studies that evaluated the association between body mass index and risk of surgical site infection following spine surgery. It is an interesting study. Nevertheless, we have several methodological issues, which we would like to communicate with the authors.1. Authors searched only two electronic databases (Pubmed and Embase) for studies reporting on risk of surgical site infection following spine surgery. Small number of required papers would be an important limitation of the review. We suggest at least three electronic databases should be systematically searched, such as OVID, the Cochrane Central Register, ClinicalTrials.gov and so on. 2. We suggest that the authors should evaluate the methodological quality of the selected studies, which could avoid the potential bias in the meta-analysis. Each included paper could be independently assessed by two reviewers using a standardized electronic form of predefined criteria. And, we would like to know how to solve the problems if there are discrepancies between the two authors. 3. Publication language was limited to English in the meta-analysis. Therefore, the authors should mention the potential importance of language bias in the limitations of their meta-analysis. 4. The authors used a random effect model to pool the data in all the forest plots even if the I 2 value of the heterogeneity was \50 %. As we know, different effect models may result in different results. Therefore, we would like to know the reason that the authors chose the random effect model for all analyses. 5. In the results part, the funnel plot was used to estimate publication bias and the symmetric inverse funnel distribution was obtained. However, it is not appropriate publication bias was assessed for adjusted OR, the number of studies was only six. As we know, a funnel plot should be inspected visually to assess for publication bias, in meta-analyses with sufficient number of studies ([9).Moreover, future studies based on prospective data collection are still needed to confirm the association between increased body mass index and spinal surgical site infection.Conflict of interest None.

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Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

Cited by 105 publications

References 70 publications

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Biofilm and Diabetic Foot Infections

Comment on Abdallah et al. entitled “Body mass index and risk of surgical site infection following spine surgery: a meta-analysis”

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