Obesity and spine surgery: relation to perioperative complications

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Object

Many patients undergoing elective thoracic or lumbar fusion procedures are obese, but the contribution of obesity to complications in spine surgery has not been defined. The authors retrospectively assessed the prevalence of obesity in a cohort of patients undergoing thoracic and lumbar fusion and correlate the presence of obesity with the incidence of operative complications.

Methods

A retrospective review of consecutive patients treated by a single surgeon (J.K.R.) over a 36-month period at either Rush University Medical Center or the Neurological and Orthopedic Institute of Chicago was performed. The authors identified 332 elective thoracic and lumbar spine surgery cases; the cohort was restricted to include only patients with symptomatic degenerative conditions in need of an anterior, posterior, or combined anterior–posterior fusion. Cases of trauma, tumor, and infection and any case in which the procedure was performed for emergency indications were excluded. A total of 97 cases were identified; of these 86 procedures performed in 84 patients had adequate follow-up material for inclusion in the present study. A broad definition of complications was used. Complications were divided into adverse events (minor) and significant complications (major) based on their impact on patient outcome. Stepwise multivariate logistic regression was used to identify which variables had a significant effect on the risk of complications. Variables considered were body mass index (BMI), height, weight, age, sex, presence or absence of diabetes mellitus (DM) and/or hypertension, number of levels fused (single compared with multiple), and type of surgery performed.

The mean BMI for the cohort was 28.8 (95% confidence interval 24.4–30.3); 60 patients (71.4%) were considered overweight or obese (BMI ≥ 25). There were 42 complications in 31 patients (36.9%); this included 19 significant complications in 17 patients (20.2%). Logistic regression revealed that the probability of a significant complication was related to BMI (p < 0.04); the chance of a significant complication was 14% with a BMI of 25, 20% with a BMI of 30, and 36% with a BMI of 40. Positioning-related palsies were only found in extremely obese patients (BMI ≥ 40). The probability of minor complication occurrence increased with age (p < 0.02), not BMI. The rate of complications was independent of sex as well as the presence of DM or hypertension. A standard collection of complications occurred, including wound infection (three cases), cerebrospinal fluid leakage (eight cases, one requiring reoperation), deep vein thrombosis (two cases), cardiac events (four cases), symptomatic pseudarthrosis (one case), pneumonia (three cases), prolonged intubation (two cases), urological issues (eight cases), positioning-related palsy (two cases), and neuropathic pain (two cases).

Conclusions

Obesity is a prevalent condition in patients undergoing elective fusion for degenerative spinal conditions and may increase the prevalence and incidence of perioperative complications. In their analysis, the authors correlated increasing BMI and increased risk of significant postoperative complications. The correlation of obesity and perioperative complications may assist in the preoperative evaluation and selection of patients for surgery.

Abbreviations used in this paper:BMI = body mass index; CI = confidence interval; DM = diabetes mellitus; DVT = deep vein thrombosis; SD = standard deviation.
Article Information

Contributor Notes

Address reprint requests to: John K. Ratliff, M.D., Department of Neurosurgery, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, Pennsylvania 19107. email: john.ratliff@jefferson.edu.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Andreshak TAn HSHall JStein B: Lumbar spine surgery in the obese patient. J Spinal Disord 10:3763791997

  • 2

    Aro SLeino P: Overweight and musculoskeletal morbidity: a ten-year follow-up. Int J Obes 9:2672751985

  • 3

    Blumenthal SMcAfee PCGuyer RDHochschuler SHGeisler FHHolt RT: A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the Charité artificial disc vs. lumbar fusion: Part I: evaluation of clinical outcomes. Spine 30:156515752005

    • Search Google Scholar
    • Export Citation
  • 4

    Brandt MHarder KWalluscheck KPSchöttler JRahimi AMöller F: Severe obesity does not adversely affect perioperative mortality and morbidity in coronary artery bypass surgery. Eur J Cardiothoracic Surg 19:6626662001

    • Search Google Scholar
    • Export Citation
  • 5

    Buchl EShelokov AGarner J: Two-year single surgeon retrospective analysis of pedicle subtraction osteotomy: analysis of complication rate and percentage correction. Spine J 5:4 SupplS272005

    • Search Google Scholar
    • Export Citation
  • 6

    Burkus JKTransfeldt EEKitchel SHWatkins RGBalderston RA: Clinical and radiographic outcomes of anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2. Spine 27:239624082002

    • Search Google Scholar
    • Export Citation
  • 7

    Chapman GW JrMailhes JBThompson HE: Morbidity in obese and nonobese patients following gynecologic surgery for cancer. J Natl Med Assoc 80:4174201988

    • Search Google Scholar
    • Export Citation
  • 8

    Damia GMascheroni DCroci MTarenzi L: Perioperative changes in functional residual capacity in morbidly obese patients. Br J Anaesth 60:5745781988

    • Search Google Scholar
    • Export Citation
  • 9

    DeMaria EJCarmody BJ: Perioperative management of special populations: obesity. Surg Clin North Am 85:128312892005

  • 10

    Dindo DMuller MKWeber MClavien PA: Obesity in general elective surgery. Lancet 361:203220352003

  • 11

    Engelman DTAdams DHByrne JGAranki SFCollins JJ JrCouper GS: Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg 118:8668731999

    • Search Google Scholar
    • Export Citation
  • 12

    Fanuele JAbdu WAHanscom BWeinstein JN: Association between obesity and functional status in patients with spine disease. Spine 27:3063122002

    • Search Google Scholar
    • Export Citation
  • 13

    Fazeli-Matin SGill ISHsu THSung GTNovick AC: Laparoscopic renal and adrenal surgery in obese patients: comparison to open surgery. J Urol 162:6656691999

    • Search Google Scholar
    • Export Citation
  • 14

    Ferree BA: Deep venous thrombosis following lumbar laminotomy and laminectomy. Orthopedics 17:35381994

  • 15

    Flegal KM: Commentary: the epidemic of obesity—what's in a name?. Int J Epidemiol 35:72742006

  • 16

    Flegal KM: Epidemiologic aspects of overweight and obesity in the United States. Physiol Behav 86:5996022005

  • 17

    Flegal KMCarroll MDKuczmarski RJJohnson CL: Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord 22:39471998

    • Search Google Scholar
    • Export Citation
  • 18

    Fox GSWhalley DGBevan DR: Anaesthesia for the morbidly obese. Experience with 110 patients. Br J Anaesth 53:8118161981

  • 19

    Garzillo MJGarzillo TA: Does obesity cause low back pain?. J Manipulative Physiol Ther 17:6016041994

  • 20

    Gepstein RShabat SArinzon ZHBerner YCatz AFolman Y: Does obesity affect the results of lumbar decompressive spinal surgery in the elderly?. Clin Orthop Relat Res 426:1381442004

    • Search Google Scholar
    • Export Citation
  • 21

    Hamilton APreface. Benzel EC: Spine Surgery: Techniques Complication Avoidance and Management New YorkChurchill Livingstone1999. 1:xix

    • Search Google Scholar
    • Export Citation
  • 22

    Hanigan WElwood PWHenderson JPLister JR: Surgical results in obese patients with sciatica. Neurosurgery 20:8968991987

  • 23

    Hedley AAOgden CLJohnson CLCarroll MDCurtin LRFlegal KM: Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA 291:284728502004

    • Search Google Scholar
    • Export Citation
  • 24

    Heliovaara MMakela MKnekt PImpivaara OAromaa A: Determinants of sciatica and low-back pain. Spine 16:6086141991

  • 25

    Holt RTMajd MIsaza JBlumenthal SMcAfee PGuyer R: Complications of lumbar artificial disc replacement vs. fusion results from the randomized multicenter FDA IDE study of the Charite artificial disc. Spine J 5:4 SupplS1002005

    • Search Google Scholar
    • Export Citation
  • 26

    Jiganti JGoldstein WMWilliams CS: A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res 289:1751791993

    • Search Google Scholar
    • Export Citation
  • 27

    Karunakar MAShah SNJerabek S: Body mass index as a predictor of complications after operative treatment of acetabular fractures. J Bone Joint Surg Am 87:149815022005

    • Search Google Scholar
    • Export Citation
  • 28

    Kilincer CSteinmetz MPSohn MJBenzel ECBingaman W: Effects of age on the perioperative characteristics and short-term outcome of posterior lumbar fusion surgery. J Neurosurg Spine 3:34392005

    • Search Google Scholar
    • Export Citation
  • 29

    Leboeuf-Yde CKyvik KOBruun NH: Low back pain and lifestyle. Part II–obesity: information from a population-based sample of 29,424 twin subjects. Spine 24:7797841999

    • Search Google Scholar
    • Export Citation
  • 30

    Mandel JLohman W: Low back pain in nurses: the relative importance of medical history, work factors, exercise, and demographics. Res Nurs Health 10:1651701987

    • Search Google Scholar
    • Export Citation
  • 31

    Mellin G: Correlations of spinal mobility with degree of chronic low back pain after correction for age and anthropometric factors. Spine 12:4644681987

    • Search Google Scholar
    • Export Citation
  • 32

    Mirtz TAGreene L: Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question. Chiropr Osteopat 13:22005

    • Search Google Scholar
    • Export Citation
  • 33

    Moulton MJCreswell LLMackey MECox JLRosenbloom M: Obesity is not a risk factor for significant adverse outcomes after cardiac surgery. Circulation 94:9 SupplII87II921996

    • Search Google Scholar
    • Export Citation
  • 34

    Nair SVerma SThuluvath PJ: Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology 35:1051092002

    • Search Google Scholar
    • Export Citation
  • 35

    National Institutes of Health: Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res 6:2 Suppl51S209S1998

    • Search Google Scholar
    • Export Citation
  • 36

    Neville ALBrown CVWeng JDemetriades DVelmahos GC: Obesity is an independent risk factor of mortality in severely injured blunt trauma patients. Arch Surg 139:9839872004

    • Search Google Scholar
    • Export Citation
  • 37

    Ogden CLCarroll MDCurtin LRMcDowell MATabak CJFlegal KM: Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295:154915552006

    • Search Google Scholar
    • Export Citation
  • 38

    Okuda SIwasaki MMiyauchi AOda TYamamoto T: Surgical complications of posterior lumbar interbody fusion with total facetectomy. Spine J 5:4 SupplS302005

    • Search Google Scholar
    • Export Citation
  • 39

    Olsen MAMayfield JLauryssen CPolish LBJones MVest J: Risk factors for surgical site infection in spinal surgery. J Neurosurg 98:2 Suppl1491552003

    • Search Google Scholar
    • Export Citation
  • 40

    Pasulka PSBistrian BRBenotti PNBlackburn GL: The risks of surgery in obese patients. Ann Intern Med 104:5405461986

  • 41

    Pietri FLeclerc ABoitel LChastang JFMorcet JFBlondet M: Low-back pain in commercial travelers. Scand J Work Environ Health 18:52581992

    • Search Google Scholar
    • Export Citation
  • 42

    Rajaraman VVingan RRoth PHeary RFConklin LJacobs GB: Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91:1 Suppl60641999

    • Search Google Scholar
    • Export Citation
  • 43

    Rasmussen KLNeumann GLjungstrom BHansen VLauszus FF: The influence of body mass index on the prevalence of complications after vaginal and abdominal hysterectomy. Acta Obstet Gynecol Scand 83:85882004

    • Search Google Scholar
    • Export Citation
  • 44

    Ray CD: Threaded titanium cages for lumbar interbody fusions. Spine 22:6676801997

  • 45

    Rokito SESchwartz MCNeuwirth MG: Deep vein thrombosis after major reconstructive spinal surgery. Spine 21:8538591996

  • 46

    Sebring LGallagher MRMueller WMBenzel ECThe obese patient. Benzel EC: Spine Surgery: Techniques Complication Avoidance and Management New YorkChurchill Livingstone1999. 905915

    • Search Google Scholar
    • Export Citation
  • 47

    Spicer DDSchaper LAPomeroy DLBadenhausen WE JrCurry JISuthers KE: Cementless cup fixation in total hip arthroplasty after 5–8 years. Int Orthop 25:2862892001

    • Search Google Scholar
    • Export Citation
  • 48

    Telfeian AEReiter GTDurham SRMarcotte P: Spine surgery in morbidly obese patients. J Neurosurg 97:1 Suppl20242002

  • 49

    Wimmer CGluch HFranzreb MOgon M: Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:1241281998

    • Search Google Scholar
    • Export Citation
  • 50

    Zacharias ASchwann TARiordan CJDurham SJShah ASHabib RH: Obesity and risk of new-onset atrial fibrillation after cardiac surgery. Circulation 112:324732552005

    • Search Google Scholar
    • Export Citation
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