Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis

Abstract

This study assessed the rate of adverse wound events in individuals with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and sought to determine if obesity was related to the rate of adverse wound events. A retrospective review of patients with adolescent idiopathic scoliosis that underwent posterior spinal fusion between 2001 and 2013 was performed. Preoperative, perioperative, and postoperative data, including wound adverse events, were obtained through medical record review. Using the Center for Disease Control BMI criteria, participants were grouped into overweight/obese (BMI%≥85 percentile) or healthy/underweight (BMI%<85 percentile) groups. Obesity and prolonged hospital stay were independent risk factors for increased risk of wound problems.

Surgical Outcomes of Obese Patients With Adolescent Idiopathic Scoliosis From Endemic Areas of Obesity in the United States

“…The overall rates of superficial and deep infection rates were 2.4% and 1.7%, respectively. These fall within the ranges of previously reported rates,4,7–10,13 although the ranges vary widely. Similar investigations have shown an association between obesity and postoperative infection rate for patients with AIS undergoing PSF.…”

“…The current consensus in the literature is also unclear, as some authors have demonstrated significant associations between obesity and EBL, 5,6 while others have not. 7,13,14 There are a number of limitations to this study. First, due to its retrospective and multicenter nature, there is an inherent potential for selection and reporting bias, leading to potential inconsistency in how outcome variables are reported, including SSIs in this study.…”

“…Since Medicare ceased hospital reimbursement for surgical site infections (SSIs)-a "never event"-more than a decade ago, 3 most of the literature examining the association between obesity and surgical outcomes in AIS has focused on the incidence of infection. Researchers have arrived at contradicting conclusions: some found that obese patients experience longer surgical times, 4,5 greater estimated blood loss (EBL), 5,6 and more SSIs or wound complications, 4,[7][8][9][10][11][12] while others demonstrated no difference in surgical times, 7,13,14 EBL, 7,13,14 or infection rates/ wound complications. 13,15 A number of factors likely played a role in the heterogeneity of these findings including: definitions of overweight and obesity that were nonadherent to the Center for Disease Control and Prevention (CDC) guidelines, procedures other than posterior spinal fusion (PSF), patient populations with nonidiopathic diagnoses, varying definitions of infections, and the fact that many of these studies were underpowered.…”

Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches?

“…While outcomes are reported to be satisfactory and often comparable among obese and nonobese patients treated with surgery when needed, peri-operative complications rate seems to be higher in most of the analyzed papers with few exceptions ( Table 3 ). 60 , 62 , 63 , 65 , 66 , 70 , 73 , 77 , 78 , 80 , 82 , 86 , 88 , 90 , 92 - 94 , 97 , 101 , 102 , 105 , 107 , 109 - 112 , 114 , 116 , 118 , 123 , 125 , 126 , 129 , 131 , 133 , 135 , 139 - 141 , 146 - 148 , 151 - 153 , 166 -...…”

Does Obesity Affect Preoperative Shoulder Balance in Adolescent Idiopathic Scoliosis?

“…Childhood obesity is an epidemic in the USA, with many downstream effects on the musculoskeletal system. For patients with adolescent idiopathic scoliosis (AIS), the recent literature has revealed that obese children may have larger curves on initial presentation [1][2][3][4], may fail brace treatment more often [1,5], experience longer operative times for surgical treatment of their spine deformities, and suffer from a higher rate of surgical site infections [4,6,7].…”