Outcomes and revision rates in normal, overweight, and obese patients 5 years after lumbar fusion

Owens, R. Kirk; Djurasovic, Mladen; Onyekwelu, Ikemefuna; Bratcher, Kelly R.; McGraw, Katlyn E.; Carreon, Leah Y.

doi:10.1016/j.spinee.2016.06.005

Cited by 37 publications

(20 citation statements)

References 27 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous studies con rm that the elderly, obese patients and male gender are associated with longer operative time. [11,12,15] However, this study reported that there is no signi cant difference in terms of age, sex, and BMI between low-di culty and high-di culty groups of ACSS.…”

Section: Discussioncontrasting

confidence: 53%

Establishment of a Nomogram for Predicting the Surgical Difficulty of Anterior Cervical Spine Surgery

Rong

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundFor a long time, surgical difficulty is mainly evaluated based on subjective perception rather than objective indexes. Moreover, the lack of systematic research regarding the evaluation of surgical difficulty potentially has a negative effect in this field. This study was aimed to evaluate the risk factors for the surgical difficulty of anterior cervical spine surgery (ACSS).MethodsThis was a retrospective cohort study totaling 291 consecutive patients underwent ACSS from 2012.3 to 2017.8. The surgical difficulty of ACSS was defined by operation time longer than 120 min or intraoperative blood loss equal to or greater than 200ml. Evaluation of risk factors was performed by analyzing the patient’s medical records and radiological parameters such as age, sex, BMI, operation level, high signal intensity on T2-weighted images, ossified posterior longitudinal ligament (OPLL), sagittal and coronal cervical circumference, cervical length, spinal canal occupational ratio, coagulation function index and platelet count.ResultsSignificant differences were reported between low-difficulty and high-difficulty ACSS groups in terms of age (p=0.017), sex (p=0.006), operation level (p<0.001), high signal intensity (p<0.001), OPLL (p<0.001) and spinal canal occupational ratio (p<0.001). Multivariate logistic regression analysis revealed that operation level (OR=5.224, 95%CI=2.125-12.843, p<0.001), high signal intensity (OR=4.994, 95%CI=1.636-15.245, p=0.005), OPLL (OR=6.358, 95%CI=1.932-20.931, p=0.002) and the spinal canal occupational ratio>0.45 (OR=3.988, 95%CI=1.343-11.840, p=0.013) were independently associated with surgical difficulty in ACSS. A nomogram was established and ROC curve gave a 0.906 C-index. There was a good calibration curve for difficulty estimation.ConclusionThis study indicated that the operational level, OPLL, high signal intensity, and spinal canal occupational ratio were independently associated with surgical difficulty and a predictive nomogram can be established using the identified risk factors. Optimal performance was achieved for predicting surgical difficulty of ACSS based on preoperative factors.

show abstract

Section: Discussioncontrasting

confidence: 53%

Establishment of a Nomogram for Predicting the Surgical Difficulty of Anterior Cervical Spine Surgery

Rong

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This finding is in agreement with much of the literature regarding both cervical and lumbar fusion procedures. 8,14,23 In a study of 672 patients undergoing ACDF, van Eck et al determined that the need for revision was not affected by variables such as BMI, age, sex, smoking status, or number of levels fused. 23 Owens et al, utilizing propensity-matched cohorts among 560 lumbar fusion patients with long-term follow-up, demonstrated that the revision rate and time between the index and revision surgeries did not differ among normal-weight, overweight, and obese groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

show abstract

“… 24 The impact of obesity was also overestimated by 1.23 relative risk and may be due to recent studies focusing on the effects of this modifiable risk factor. 18 , 25 Finally, the underestimated impact of preoperative anemia, although not statistically significant, may be explained by a stringent American College of Surgeons NSQIP definition for this status. 11 …”

Section: Discussionmentioning

confidence: 98%

General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons’ Perceptions and Reported Data for Rates and Risk Factors

Ondeck

Bohl

Bovonratwet

et al. 2017

Global Spine Journal

View full text Add to dashboard Cite

Study Design:Survey study and retrospective review of prospective data.Objectives:To contrast surgeons’ perceptions and reported national data regarding the rates of postoperative adverse events following anterior cervical discectomy and fusion (ACDF) and to assess the accuracy of surgeons in predicting the impact of patient factors on such outcomes.Methods:A survey investigating perceived rates of perioperative complications and the perceived effect of patient risk factors on the occurrence of complications following ACDF was distributed to spine surgeons at the Cervical Spine Research Society (CSRS) 2015 Annual Meeting. The equivalent reported rates of adverse events and impacts of patient risk factors on such complications were assessed in patients undergoing elective ACDF from the National Surgical Quality Improvement Program (NSQIP).Results:There were 110 completed surveys from attending physicians at CSRS (response rate = 44%). There were 18 019 patients who met inclusion criteria in NSQIP years 2011 to 2014. The rates of 11 out of 17 (65%) postoperative adverse events were mildly overestimated by surgeons responding to the CSRS questionnaire in comparison to reported NSQIP data (overestimates ranged from 0.24% to 1.50%). The rates of 2 out of 17 (12%) postoperative adverse events were mildly underestimated by surgeons (range = 0.08% to 1.2%). The impacts of 5 out of 10 (50%) patient factors were overestimated by surgeons (range relative risk = 0.56 to 1.48).Conclusions:Surgeon estimates of risk factors for and rates of adverse events following ACDF procedures were reasonably nearer to national data. Despite an overall tendency toward overestimation, surgeons’ assessments are roughly appropriate for surgical planning, expectation setting, and quality improvement initiatives.

show abstract

Outcomes and revision rates in normal, overweight, and obese patients 5 years after lumbar fusion

Cited by 37 publications

References 27 publications

Establishment of a Nomogram for Predicting the Surgical Difficulty of Anterior Cervical Spine Surgery

Establishment of a Nomogram for Predicting the Surgical Difficulty of Anterior Cervical Spine Surgery

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

General Health Adverse Events Within 30 Days Following Anterior Cervical Discectomy and Fusion in US Patients: A Comparison of Spine Surgeons’ Perceptions and Reported Data for Rates and Risk Factors

Contact Info

Product

Resources

About