More risks and complications for elective spine surgery in morbidly obese patients

Abstract

Background:The vast majority of studies emphasize the greater morbidity/mortality for elective spine surgery in morbidly obese patients.Methods:This review focuses on the increased morbidity/mortality of performing elective spinal operations in morbidly obese patients. There are two definitions of morbid obesity; a body mass index (BMI) of equal to or greater than 35 plus two major comorbid factors (e.g., hypertension, diabetes, etc.) or a BMI (morbidly obese III) of =≥40 kg/m2.Results:For patients undergoing spinal surgery, morbid obesity increases perioperative morbidity/mortality for various reasons. The quality of preoperative and intraoperative imaging is often compromised potentially leading to mistaken preoperative diagnoses, and wrong level surgery. Resultant major technical surgical limitations include poor/inadequate operative exposure, and the risk of suboptimal placement of instrumentation There is also increased exposure to major perioperative complications such as deep venous thrombosis, pulmonary embolism, infection, pneumonia, cardiac complications, blindness in the prone position, brachial and lumbar plexus injuries, increased anesthetic risks (e.g., even using awake intubation/awake positioning), and postoperative wound seromas/hematomas.Conclusions:Most of the spinal literature documents the marked increased perioperative morbidity/mortality for morbidly obese patients undergoing elective spine surgery. If elective surgery is warranted in these patients, the risks and timing of surgical intervention should include consideration of major preoperative weight loss strategies including bariatric procedures to optimize outcomes.

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

“…20 Degenerative scoliosis, excessive body weight, and number of spinal levels involved are also notable risk factors for reoperation. 21,22 Intraoperative blood loss, combined comorbidities, 23 and preoperative hemoglobin level are possible risk factors according to previous studies. 24,25 Our study showed a strong relationship between the number of diseased segments and time to re-surgery; however, age and sex were not significant risk factors in the present study.…”

Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion

“…Within the general spine literature, obesity has been widely associated with increased complication incidence. [34][35][36][37][38][39][40] Regarding surgical complications specifically, multiple studies have demonstrated an association between obesity and the incidence of surgical site infections. 35,38,39,41,42 The increased risk for surgical site infections in obese patients has been attributed to the increased risk of fat necrosis in this population, serving as a nidus for infection.…”

Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

“…9 Across a wide spectrum of surgical procedures, obesity has been shown to be a risk factor for surgical complications, including delayed wound healing and wound failure, surgical site infection, and postoperative venous thromboembolic events (VTEs). 10–12 Although there have been few studies specifically examining obesity as a risk factor for surgical complications following gender-affirming vaginoplasty, some centers and surgeons employ BMI as a selection criteria for surgical candidacy, 13 denying vaginoplasty to patients with BMIs over an arbitrary cutoff (usually 30 or 35). 13…”