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.; Long, William D.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2013.11.047

Cited by 136 publications

(78 citation statements)

References 30 publications

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“…[61730] One study (2009) retrospectively evaluated 63 patients undergoing lumbar spinal fusion; more postoperative complications were observed for both morbidly obese (45%) and obese patients (44%) [Table 1]. [30] They also exhibited more comorbid risk factors, required longer operative times, had more perioperative complications, and later demonstrated no significant weight loss.…”

Section: Increased Morbidity For Lumbar Surgery In Morbidly Obese Patmentioning

confidence: 99%

“…[6] Of the 10387 patients undergoing lumbar surgery, 4.5% had anterior fusions, 17.9% had posterior fusions, 6.3% and TLIF/PLIF’s, 40.7% had discectomy, and 30.5% had decompressions. There were 25.6% of patients in the Obese I (30–34.9 kg/m 2 ), 11.5% in the Obese II (35–39.9 kg/m 2 ), and 6.9% in the Obese III (greater than or equal to 40 kg/m 2 ) groups.…”

Section: Increased Morbidity For Lumbar Surgery In Morbidly Obese Patmentioning

confidence: 99%

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

Epstein¹

2017

Surg Neurol Int

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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.

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Section: Increased Morbidity For Lumbar Surgery In Morbidly Obese Patmentioning

confidence: 99%

Section: Increased Morbidity For Lumbar Surgery In Morbidly Obese Patmentioning

confidence: 99%

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

Epstein¹

2017

Surg Neurol Int

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“…To more fully explore in impact of obesity on the entire spine, Teraguchi et al [24] investigated the prevalence and distribution of intervertebral disc degeneration over the entire spine and found the age and obesity were associated with the presence of disc degeneration in all areas of the spine, indicating that obesity places stress across multiple regions of back. BMI and obesity have also been identified as a risk factor for adjacent segment diseases and post-operative complications among patients undergoing lumbar fusion for degenerative spine diseases [30,31,32,33,34,35,36,37,38,39,40]. Weight control before and after the surgery was observed to reduce the incidence of adjacent segment disease and improve the fusion surgery outcome [41,42].…”

Section: Introductionmentioning

confidence: 99%

Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis

Sheng

Feng

Zhang

et al. 2017

IJERPH

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Background: The link between body weight status and spinal diseases has been suggested by a number of cross-sectional and cohort studies with a limited range of patient populations. No population-representative samples have been used to examine the link between obesity and spinal diseases. The present study is based on a nationally representative sample drawn from the Medical Expenditure Panel Survey. Methods: Using the cross-sectional sample of the 2014 Medical Expenditure Panel Study, we built four weighted logistic regression analyses of the associations between body weight status and the following four spinal diseases: low back pain, spondylosis, other cervical disorders and intervertebral disc disorder (IDD). Each respondent’s body weight status was used as the key independent variable with three categories: normal/underweight, overweight, and obese. We controlled for marital status, gender, age, smoking status, household income, health insurance coverage, educational attainment and the use of health services for other major categories of diseases. Results: A total sample of 23,048 respondents was used in our analysis. Overweight and obese respondents, as compared to normal/underweight respondents, were more likely to develop lower back problems (Overweight: logged odds = 0.218, p < 0.01; Obese: logged odds = 0.395, p < 0.001) and IDD (Overweight: logged odds = 0.441, p < 0.05; Obese: logged odds = 0.528, p < 0.001). The associations between bodyweight status and spondylitis were statistically insignificant (Overweight: logged odds = 0.281, p = 0.442; Obese: logged odds = 0.680, p = 0.104). The associations between body weight status and other cervical disorders (Overweight: logged odds = −0.116, p = 0.304; Obese: logged odds = −0.160, p = 0.865) were statistically insignificant. Conclusions: As the first study using a national sample to study bodyweight and spinal diseases, our paper supports the hypothesis that obesity adds to the burden of low back pain and IDD. Longitudinal and interventional studies are needed to understand the specific mechanisms behind these positive associations.

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“…2 Predictors associated with hospital readmission in spinal surgery have been studied, including examination of lumbar decompression, lumbar discectomy/microdiscectomy, cervical spine surgery, and posterior spinal fusion procedures. 3–11 …”

Section: Introductionmentioning

confidence: 99%

“…However, few studies have addressed predictors for hospital readmission or readmission rates following these surgeries. Buerba et al 5 identified 6.3% of 10 387 patients in American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database had undergone TLIF/PLIF from 2005-2010 but the authors did not investigate the risk of readmission. In this study, we used the national validated multicenter ACS-NSQIP database to examine the percentage of 30-day readmission and risk factors associated with 30-day readmission for patients undergoing elective single level TLIF spine surgery.…”

Section: Introductionmentioning

confidence: 99%

Thirty-Day Readmission Risk Factors Following Single-Level Transforaminal Lumbar Interbody Fusion (TLIF) for 4992 Patients From the ACS-NSQIP Database

García

Khanna

Dahdaleh

et al. 2017

Global Spine Journal

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Study Design:Retrospective cohort study.Objective:To describe the readmission rate and identify risk factors associated with 30-day readmission after transforaminal lumbar interbody fusion (TLIF) surgery.Methods:Patients who underwent elective single level TLIF surgery from 2011 to 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Emergency or trauma cases were excluded. Preoperative, intraoperative, and postoperative variables were extracted. A multivariate binary regression identified predictors correlated with 30-day readmission.Results:A total of 4992 patients were included in the analysis. The overall 30-day readmission rate was 5.51% (275/4992) for readmissions reported between 2011 to 2013. The mean age of patients readmitted was 62.40 years (standard error [SE] = 0.78) and 60.92 years (SE = 0.20) among those whom were not readmitted (P = .05). The top three causes for readmission included postoperative pain control, deep or superficial surgical site infections. Predictors associated with 30-day readmission in a multivariate analysis included female gender (odds ratio [OR] = 1.27, 95% CI = 0.97-1.65), history of severe chronic obstructive pulmonary disease (OR = 1.81, 95% CI = 1.11-2.96), and in the postoperative period, American Society of Anesthesiologists class (OR = 1.30, 95% CI = 1.04-1.63), presence of superficial surgical site infection (OR= 18.23, 95% CI = 10.36-32.08), or urinary tract infection (OR = 4.93, 95% CI = 2.84-8.58).Conclusions:The readmission rate, risk factors, and causes following TLIF surgery are comparable to other lumbar spinal procedures reported from the ACS-NSQIP database.

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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 136 publications

References 30 publications

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

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

Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis

Thirty-Day Readmission Risk Factors Following Single-Level Transforaminal Lumbar Interbody Fusion (TLIF) for 4992 Patients From the ACS-NSQIP Database

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