Effects of Body Mass Index on Perioperative Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgery

Abstract

Objective Obesity has become a public health crisis and continues to be on the rise. An elevated body mass index has been linked to higher rates of spinal degenerative disease requiring surgical intervention. Limited studies exist that evaluate the effects of obesity on perioperative complications in patients undergoing anterior cervical discectomy and fusion (ACDF). Our study aims to determine the incidence of obesity in the ACDF population and the effects it may have on postoperative inpatient complications. Methods The National Inpatient Sample was evaluated from 2004 to 2014 and discharges with International Classification of Diseases procedure codes indicating ACDF were identified. This cohort was stratified into patients with diagnosis codes indicating obesity. Separate univariable followed by multivariable logistic regression analysis were performed for the likelihood of perioperative inpatient outcomes among the patients with obesity. Results From 2004 to 2014, estimated 1,212,475 ACDFs were identified in which 9.2% of the patients were obese. The incidence of obesity amongst ACDF patients has risen dramatically during those years from 5.8% to 13.4%. Obese ACDF patients had higher inpatient likelihood of dysphagia, neurological, respiratory, and hematologic complications as well as pulmonary emboli, and intraoperative durotomy. Conclusion Obesity is a well-established modifiable comorbidity that leads to increased perioperative complications in various surgical specialties. We present one of the largest retrospective analyses evaluating the effects of obesity on inpatient complications following ACDF. Our data suggest that the number of obese patients undergoing ACDF is steadily increasing and had a higher inpatient likelihood of developing perioperative complications.

National Trends and Correlates of Dysphagia After Anterior Cervical Discectomy and Fusion Surgery

“…The authors have suggested the association between obesity and early-dysphagia may be linked to the increased thickness of the prevertebral tissue in obese patients, leading to difficulty in manipulation and excessive esophageal retraction. 26,30,31 Finally, while no past study has elucidated the implication of frailty in the development of dysphagia, the present publication demonstrated a significant association. Frailty which is defined as hypoalbuminemia, muscle weakness or fatigue may make patients especially susceptible to more intraoperative tissue manipulation and thus at increased risk of postoperative dysphagia.…”

“…Similarly, Wang et al [ 26 ] and Liu et al [ 30 ] found increased rates in the immediate postoperative period only. The authors have suggested the association between obesity and early-dysphagia may be linked to the increased thickness of the prevertebral tissue in obese patients, leading to difficulty in manipulation and excessive esophageal retraction [ 26 , 30 , 31 ]. Finally, while no past study has elucidated the implication of frailty in the development of dysphagia, the present publication demonstrated a significant association.…”

Zero-Profile Device Implantation in Anterior Cervical Discectomy and Fusion: A Single Institute Experience

“…(25) Obese patients had a greater potential for complications such as intra-operative durotomy, dysphagia, neurological, cardiopulmonary, and hematologic complications following ACDF procedures. (26) Basques et al reported that obesity did not impact clinical outcomes but affected cervical sagittal alignment and adjacent segment degeneration in a short term follow-up after ACDF. (27) In the current study, although the two cases with postoperative dysphagia were classified as obese, after multivariate analysis, the author found the relationship without statistical significance.…”

Incidence and Clinical Outcomes of Hypothyroidism in Patients Undergoing Spinal Fusion

“…Yet, as our population continues to age and thus continues to develop and live with chronic illnesses, perioperative harm reduction becomes ever more imperative. Diabetes mellitus (DM), obesity, systemic malignancy, and cardiovascular disease are all conditions associated with an increased risk of perioperative adverse events in spine surgery [1]. However, hypothyroidism, which carries a prevalence of approximately 1%-4% in the US and has been independently associated with the development of hypertension, cardiovascular disease, osteoporosis, peripheral neuropathy, muscular weakness, and increased complication rates in non-spinal surgeries, has had only a limited number of studies suggesting that it confers increased perioperative risk in patients undergoing major spine surgery [2][3][4][5][6][7][8][9][10].…”