Taylor D Ottesen1, Rohil Malpani1, Anoop R Galivanche1, Cheryl K Zogg1, Arya G Varthi1, Jonathan N Grauer2. 1. Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA. 2. Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA. Electronic address: jonathan.grauer@yale.edu.
Abstract
BACKGROUND CONTEXT: Past studies have focused on the association of high body mass index (BMI) on spine surgery outcomes. These investigations have reported mixed conclusions, possible due to insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (e.g. underweight, overweight, and obese). Few studies have considered outcomes of patients with low BMI. PURPOSE: To analyze how anterior cervical spine surgery outcomes track with World Health Organization categories of BMI to better assess where along the BMI spectrum patients are at risk for adverse perioperative outcomes. DESIGN/ SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients undergoing elective anterior cervical spine surgery were abstracted from the 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program database. OUTCOME MEASURES: Thirty-day adverse events, hospital readmissions, postoperative infections, and mortality. METHODS: Patients undergoing anterior cervical spine procedures (anterior cervical discectomy and fusion, anterior cervical corpectomy, cervical arthroplasty) were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Patients were then aggregated into modified World Health Organization categories of BMI. Odds ratios of adverse outcomes, normalized to average risk of normal weight subjects (BMI 18.5-24.9 kg/m2), were calculated. Multivariate analyses were then performed on aggregated adverse outcome categories controlling for demographics (age, sex, functional status) and overall health as measured by the American Society of Anesthesiologists classification. RESULTS: In total, 51,149 anterior cervical surgery patients met inclusion criteria. Multivariate analyses revealed the odds of any adverse event to be significantly elevated for underweight and super morbidly obese patients (Odds Ratios [OR] of 1.62 and 1.55, respectively). Additionally, underweight patients had elevated odds of serious adverse events (OR=1.74) and postoperative infections (OR=1.75) and super morbidly obese patients had elevated odds of minor adverse events (OR=1.72). Relative to normal BMI patients, there was no significant elevation for any adverse outcomes for any of the other overweight/obese categories, in fact some had reduced odds of various adverse outcomes. CONCLUSIONS: Underweight and super morbidly obese patients have the greatest odds of adverse outcomes after anterior cervical spine surgery. The current study identifies underweight patients as an at-risk population that has previously not received significant focus. Physicians and healthcare systems should give additional consideration to this population, as they often already do for those at the other end of the BMI spectrum.
BACKGROUND CONTEXT: Past studies have focused on the association of high body mass index (BMI) on spine surgery outcomes. These investigations have reported mixed conclusions, possible due to insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (e.g. underweight, overweight, and obese). Few studies have considered outcomes of patients with low BMI. PURPOSE: To analyze how anterior cervical spine surgery outcomes track with World Health Organization categories of BMI to better assess where along the BMI spectrum patients are at risk for adverse perioperative outcomes. DESIGN/ SETTING: Retrospective cohort study. PATIENT SAMPLE: Patients undergoing elective anterior cervical spine surgery were abstracted from the 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program database. OUTCOME MEASURES: Thirty-day adverse events, hospital readmissions, postoperative infections, and mortality. METHODS: Patients undergoing anterior cervical spine procedures (anterior cervical discectomy and fusion, anterior cervical corpectomy, cervical arthroplasty) were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Patients were then aggregated into modified World Health Organization categories of BMI. Odds ratios of adverse outcomes, normalized to average risk of normal weight subjects (BMI 18.5-24.9 kg/m2), were calculated. Multivariate analyses were then performed on aggregated adverse outcome categories controlling for demographics (age, sex, functional status) and overall health as measured by the American Society of Anesthesiologists classification. RESULTS: In total, 51,149 anterior cervical surgery patients met inclusion criteria. Multivariate analyses revealed the odds of any adverse event to be significantly elevated for underweight and super morbidly obese patients (Odds Ratios [OR] of 1.62 and 1.55, respectively). Additionally, underweight patients had elevated odds of serious adverse events (OR=1.74) and postoperative infections (OR=1.75) and super morbidly obese patients had elevated odds of minor adverse events (OR=1.72). Relative to normal BMI patients, there was no significant elevation for any adverse outcomes for any of the other overweight/obese categories, in fact some had reduced odds of various adverse outcomes. CONCLUSIONS: Underweight and super morbidly obese patients have the greatest odds of adverse outcomes after anterior cervical spine surgery. The current study identifies underweight patients as an at-risk population that has previously not received significant focus. Physicians and healthcare systems should give additional consideration to this population, as they often already do for those at the other end of the BMI spectrum.
Keywords:
American College of Surgeons National Surgical Quality Improvement Program (NSQIP); Anterior cervical spine; Body mass index (BMI); Mortality; Perioperative adverse events; Readmission; Risk factors; Underweight
Authors: Patawut Bovonratwet; Matthew L Webb; Nathaniel T Ondeck; Adam M Lukasiewicz; Jonathan J Cui; Ryan P McLynn; Jonathan N Grauer Journal: Clin Orthop Relat Res Date: 2017-12 Impact factor: 4.176
Authors: Abishek Iyer; David P Fairlie; Johannes B Prins; Bruce D Hammock; Lindsay Brown Journal: Nat Rev Endocrinol Date: 2010-02 Impact factor: 43.330
Authors: Matthew J McGirt; Saniya S Godil; Anthony L Asher; Scott L Parker; Clinton J Devin Journal: Neurosurg Focus Date: 2015-12 Impact factor: 4.047
Authors: Roslyn C Tarrant; Sam Lynch; Padraig Sheeran; Padhraig F O'Loughlin; Michelle Harrington; David P Moore; Patrick J Kiely Journal: Spine (Phila Pa 1976) Date: 2014-01-15 Impact factor: 3.468
Authors: Nimesh Patel; Bradley Bagan; Sumeet Vadera; Mitchell Gil Maltenfort; Harel Deutsch; Alexander R Vaccaro; James Harrop; Ashwini Sharan; John K Ratliff Journal: J Neurosurg Spine Date: 2007-04
Authors: Taylor D Ottesen; Ryan P McLynn; Cheryl K Zogg; Blake N Shultz; Nathaniel T Ondeck; Patawut Bovonratwet; Kirthi S Bellamkonda; Lee E Rubin; Jonathan N Grauer Journal: Spine J Date: 2018-08-02 Impact factor: 4.166
Authors: Menachem M Meller; Nader Toossi; Norman A Johanson; Mark H Gonzalez; Min-Sun Son; Edmund C Lau Journal: J Arthroplasty Date: 2016-03-10 Impact factor: 4.757
Authors: Michela Faggioni; Usman Baber; Arash Ehteshami Afshar; Gennaro Giustino; Samantha Sartori; Sabato Sorrentino; Philippe G Steg; Giulio G Stefanini; Stephan Windecker; Martin B Leon; Gregg W Stone; William Wijns; Patrick W Serruys; Marco Valgimigli; Edoardo Camenzind; Giora Weisz; Pieter C Smits; David E Kandzari; Soren Galatius; Clemens Von Birgelen; Raban V Jeger; Ghada W Mikhail; Dipti Itchhaporia; Laxmi Mehta; Rebecca Ortega; Hyo-Soo Kim; Adnan Kastrati; Alaide Chieffo; George D Dangas; Marie-Claude Morice; Roxana Mehran Journal: JACC Cardiovasc Interv Date: 2017-12-13 Impact factor: 11.195
Authors: Shukri F Khuri; William G Henderson; Jennifer Daley; Olga Jonasson; R Scott Jones; Darrell A Campbell; Aaron S Fink; Robert M Mentzer; Leigh Neumayer; Karl Hammermeister; Cecilia Mosca; Nancy Healey Journal: Ann Surg Date: 2008-08 Impact factor: 12.969
Authors: Taylor D Ottesen; Alp Yurter; Blake N Shultz; Anoop R Galivanche; Cheryl K Zogg; Patawut Bovonratwet; Lee E Rubin; Jonathan N Grauer Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2019-08-06
Authors: Helena Sophie Leitner; Reinhard Pauzenberger; Ines Ana Ederer; Christine Radtke; Stefan Hacker Journal: J Clin Med Date: 2021-11-30 Impact factor: 4.241