Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

Abstract

Background As obesity becomes more prevalent, it becomes more common among patients considering orthopaedic surgery, including spinal surgery. However, there is some controversy regarding whether obesity is associated with complications, failed reconstructions, or reoperations after spinal surgery. Questions/purposes We wished to determine, in patients undergoing spine surgery, whether obesity is associated with (1) surgical site infection, (2) mortality and the need for revision surgery after spinal surgery, and (3) increased surgical time and blood loss. Methods A systematic literature search was performed to collect comparative or controlled studies that evaluated the influence of obesity on the surgical and postoperative outcomes of spinal surgery. Two reviewers independently selected trials, extracted data, and assessed the methodologic quality and quality of evidence. Pooled odds ratios (OR) and mean differences (MD) with 95% CIs were calculated using the fixed-effects model or random-effects model. Data were analyzed using RevMan 5.1. MOOSE criteria were used to ensure this project's validity. Thirtytwo studies involving 97,326 patients eventually were included. Results Surgical site infection (OR, 2.33; 95% CI, 1.94-2.79), venous thromboembolism (OR, 3.15; 95% CI, 1.92-5.17), mortality (OR, 2.6; 95% CI, 1.50-4.49), revision rate (OR, 1.43; 95% CI, 1.05-1.93) operating time (OR, 14.55; 95% CI,, and blood loss (MD, 28.89; 95% CI,, were all significantly increased in the obese group. Conclusion Obesity seemed to be associated with higher risk of surgical site infection and venous thromboembolism, more blood loss, and longer surgical time. Future prospective studies are needed to confirm the relationship between obesity and the outcome of spinal surgery.

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

“…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.…”

“…One possible reason for these higher rates could be that patients with higher BMIs are at risk for longer and more technically difficult procedures. 10,12,25,26,31 Decompression alone involves less time on the operating table and thus may be a preferred treatment strategy to lower risks.…”

Complication avoidance with pre-operative screening: insights from the Seattle spine team

“…Jiang et al conducted a systematic review of the literature investigating the effect of obesity on surgical outcomes and complication rates in spine surgery. According to this review, obese patients were significantly more likely to experience a higher revision rate, greater blood loss, venous thromboembolism, longer operative time, and mortality [27]. Buerba et al conducted a retrospective analysis of prospectively collected data for 10,387 patients undergoing lumbar surgery to investigate the relationship between obesity and complication risk.…”

The significance of post-operative rehabilitation in obese and overweight patients

“…Ogólna częstość hospitalizacji osób otyłych jest także więk-sza niż w przypadku pozostałej populacji [10][11][12]. Znany jest negatywny wpływ otyłości na śmiertelność i powikłania okołooperacyjne w chirurgii ogólnej [13][14][15][16][17][18], kardiochirurgii [19][20][21][22], urologii [23], chirurgii klatki piersiowej [24][25], ortopedii [26][27][28] i neurochirurgii [29]. Otyłość generuje więc For many years, the obesity epidemic has been observed in advanced countries, Poland included [1].…”

“…The general number of hospitalisations of obese patients is greater compared to other members of population [10][11][12]. The negative effects of obesity on mortality and perioperative complications in general surgery [13][14][15][16][17][18], cardiac surgery [19][20][21][22], urology [23], chest surgery [24][25], orthopaedics [26][27][28] and neurosurgery [29] are well known. dużo wyższe koszty opieki szpitalnej, jak i ambulatoryjnej [30][31][32].…”