Is Obesity in Adolescent Idiopathic Scoliosis Associated With Larger Curves and Worse Surgical Outcomes?

Li, Ying; Binkowski, Laura; Grzywna, Alexandra; Robbins, Christopher; Caird, Michelle S.; Farley, Frances A.; Glotzbecker, Michael

doi:10.1097/brs.0000000000001721

Cited by 25 publications

(29 citation statements)

References 10 publications

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“…It is interesting to note that the OB patients were the youngest on average (13.7 vs 14.5 years for NW patients vs 14.1 years for OW patients, p < 0.001). This has been shown previously 11 and may be attributable to the fact that obese patients can present with worse curves initially, or to the decreased effectiveness of brace treatment. 14 Likewise, the OB patients were more likely to undergo fusion of 13 or more spinal levels, suggesting that they, in fact, may present with more severe curves, as has been postulated previously.…”

Section: Discussionmentioning

confidence: 52%

“…10 Interestingly, other studies have not found higher complication rates in obese patients undergoing AIS surgery. 9,11,18 Although Hardesty et al showed a difference in operative times and blood loss, their complication rate was not significantly different between normal-weight (15%) and obese (14%) patients (p = 0.950). Li et al retrospectively analyzed the outcomes of 588 patients (454 normal weight, 63 overweight, and 71 obese patients), finding no significant differences in intraoperative or postoperative complications between the normal-weight and overweight patients (postoperative: 21.8% vs 23.9%, p = 0.612) or between the normal-weight and obese patients (postoperative: 21.8% vs 28.2%, p = 0.234).…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, obese patients have been shown to have more severe major curves at presentation, preoperative minor curves, and preoperative thoracic kyphosis compared with normalweight patients. 11 In the present study, we used a large multicenter prospective database to examine 30-day outcomes after AIS surgery, finding that the OB patients had significantly longer operative/anesthesia times, higher 30-day complication, readmission, and reoperation rates, and longer hospital stays. It is interesting to note that the OB patients were the youngest on average (13.7 vs 14.5 years for NW patients vs 14.1 years for OW patients, p < 0.001).…”

Section: Discussionmentioning

confidence: 93%

“…19 In the adult literature, obesity has been shown to increase the risk of perioperative complications after spinal surgery, particularly wound complications. [4][5][6]16 Nonetheless, there are conflicting data in the pediatric population, with some studies finding a negative impact from obesity 1,[9][10][11] and others finding no significant difference in outcomes. 2,18 Thus, the purpose of this investigation was to examine the impact of obesity on 30-day outcomes after posterior spinal fusion for AIS, with an emphasis on complication rates based on body mass index (BMI).…”

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confidence: 99%

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Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Ramos

Nakhla

Nasser

et al. 2017

Neurosurgical Focus

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OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified as NW, 345 (12.7%) as OW, and 357 (13.2%) as OB. The overall complication rate was 1.3% (36/2712). For NW and OW patients, the complication rate was 0.9% in each group; for OB patients, the rate was 4.2% (p < 0.001). The 30-day readmission rate was 2.0% (55/2712) for all patients, 1.6% for NW patients, 1.2% for OW patients, and 5.0% for OB patients (p < 0.001). The 30-day reoperation rate was 1.4% (39/2712). Based on BMI, this reoperation rate corresponded to 0.9%, 1.2%, and 4.8% for NW, OW, and OB patients, respectively (p < 0.001). After controlling for patient age, number of spinal levels fused, and operative/anesthesia time on multiple logistic regression analysis, obesity remained a significant risk factor for complications (OR 4.61), readmissions (OR 3.16), and reoperations (OR 5.33; all p < 0.001).CONCLUSIONSBody mass index may be significantly associated with short-term outcomes after long-segment fusion procedures for AIS. Although NW and OW patients may have similar 30-day outcomes, OB patients had significantly higher wound complication, readmission, and reoperation rates and longer hospital stays than the NW patients. The findings of this study may help spine surgeons and patients in terms of preoperative risk stratification and perioperative expectations.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

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Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Ramos

Nakhla

Nasser

et al. 2017

Neurosurgical Focus

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“…It is understandable that external body dimension does not necessarily match with the internal anatomical configuration910. Conversely, some studies suggest a higher BMI at presentation to a scoliosis clinic is associated with larger Cobb angles111213.…”

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confidence: 99%

The Height-Width-Depth Ratios of the Intervertebral Discs and Vertebral Bodies in Adolescent Idiopathic Scoliosis vs Controls in a Chinese Population

Chen

Schlösser

Brink

et al. 2017

Sci Rep

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Adolescent idiopathic scoliosis (AIS) patients have been reported to be taller and more slender than normal controls, suggesting less mechanical stiffness of their trunk and spine. For assessment of mechanical stiffness, to our best knowledge this is the first to study height-width-depth relations at the level of the individual vertebra and disc in 3-D and to evaluate its relation with the Cobb angle severity. A unique series of high-resolution pre-operative computed tomographic (CT) scans of a total of 105 Chinese patients with moderate to severe AIS and 11 age-matched non-scoliotic controls were used for this study. It was found that some geometric relations differed between primary thoracic curves, secondary curves and normal controls at the individual affected vertebra and disc level. The scoliotic discs in the primary curves were relatively more slender (taller and thinner) than in secondary curves and as compared to controls. In the lumbar spinal area, the vertebral bodies were more slender in the primary as well as secondary AIS curves as compared to the controls. Therefore, if all material properties remain the same, our finding indicates that scoliotic spines may be mechanically less stiff than normal spines. No significant correlation between any of the measures and Cobb angle severity was found.

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Body mass index affects outcomes after vertebral body tethering surgery

et al. 2022

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Is Obesity in Adolescent Idiopathic Scoliosis Associated With Larger Curves and Worse Surgical Outcomes?

Abstract: 3.

Cited by 25 publications

References 10 publications

Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis

The Height-Width-Depth Ratios of the Intervertebral Discs and Vertebral Bodies in Adolescent Idiopathic Scoliosis vs Controls in a Chinese Population

Body mass index affects outcomes after vertebral body tethering surgery

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