Obese Class III Patients at Significantly Greater Risk of Multiple Complications After Lumbar Surgery: An Analysis of 10,387 Patients in the ACS-NSQIP Database

Buerba, Rafael A.; Fu, Michael C.; Gruskay, Jordan A.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2013.07.220

Cited by 24 publications

(37 citation statements)

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“…1,3,14,29 These findings may be attributable to patient positioning, soft-tissue dissection, and inefficient or absent specialized equipment to enable expedient surgical intervention. With respect to hospital stay, it is plausible that the higher prevalence of comorbid conditions seen in the obese group-for example, obstructive airway disease, hypertension, diabetes mellitus, and coronary artery disease-may complicate recovery and consequentially extend the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…1,13,20,27 Interestingly, a handful of others have equally disagreed with this association. 15,22,30,32 Buerba et al 3 suggested that a BMI threshold ≥ 40 kg/m 2 may be more of a risk factor for SSI than all BMIs > 30 kg/m 2 . Overall, serum glucose levels or diabetes may be an even stronger risk factor for SSI than one's BMI, especially since this metric can be influenced by muscle mass or muscular body habitus and is not necessarily a surrogate of poor health.…”

Section: Discussionmentioning

confidence: 99%

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

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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“…However, according to current literature, BMI is not likely to change significantly following lumbar spine fusion. Vaidya et al showed BMI actually increased by an average of 1.5kg at an average follow up of 20 months [5]. Finally, BMI is a relatively imprecise indicator of obesity and other more accurate measurements such as skin fold thickness or body surface area may have represented a more precise value of obesity [42].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have linked obesity to high rates of low back pain and lumbar degenerative disc disease [2][3][4]. When compared to non-obese patients, obese patients undergoing surgical lumbar decompression have been shown to have greater rates of perioperative and postoperative complications, yet have demonstrated equivalent outcomes regarding improvement in pain and functional disability [5][6][7][8][9][10][11][12]. Thus, the obese patient presents a unique challenge to the treating physician as the benefits of lumbar surgery are weighed against the high rate of potential complications.…”

Section: Introductionmentioning

confidence: 99%

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

McAnany¹,

Overley²,

Andelman³

et al. 2015

Integr Obesity Diabetes

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“…Obese patients (BMI = 30 to 39.9) had a significantly increased risk of urinary and wound complications. Patients with a BMI of 40 or more experienced significantly increased operative time and extended length of stay and were at significantly greater risk of complications, particularly pulmonary complications [28]. Marquez-Lara et al conducted an analysis of data from 24, 196 patients who underwent lumbar spine surgery between 2006 and 2011.…”

Section: Preoperative Evaluation Literaturementioning

confidence: 99%

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

Buchlak

Yanamadala

Lévêque

et al. 2016

Curr Rev Musculoskelet Med

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Complication rates for complex adult lumbar scoliosis surgery are unacceptably high. Standardized preoperative evaluation protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. To increase patient safety and reduce complication risk, an entire medical and surgical team should work together to care for adult lumbar scoliosis patients. This article describes preoperative patient evaluation strategies with a particular focus on adult lumbar scoliosis surgery involving six or more levels of spinal fusion. Domains considered include recent preoperative evaluation literature, predictive risk modeling, the appropriate management of medical conditions, and the composition and activities of a multidisciplinary conference review team. An evidence-based comprehensive systematic preoperative surgical evaluation process is described.

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Obese Class III Patients at Significantly Greater Risk of Multiple Complications After Lumbar Surgery: An Analysis of 10,387 Patients in the ACS-NSQIP Database

Cited by 24 publications

References 0 publications

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

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

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

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

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