Deeptee Jain1, Wesley Durand2, Jeremy D Shaw3, Shane Burch4, Vedat Deviren4, Sigurd Berven4. 1. Department of Orthopaedic Surgery, Washington University, St. Louis, MO. 2. Alpert School of Medicine, Brown University, Providence, RI. 3. Department of Orthopaedic Surgery, University of Pittsburg, Pittsburg, PA. 4. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.
Abstract
STUDY DESIGN: Retrospective case-control study. OBJECTIVE: The aim of this study was to determine the influence of obesity on risk factors for adverse outcome after lumbar spine fusion (LSF). SUMMARY OF BACKGROUND DATA: Obesity is risk factor for complications after LSF and poses unique challenges regarding optimization of care. Nonetheless, this patient population is not well-studied. METHODS: Adult patients undergoing LSF were identified the State Inpatient Database. Patients were identified as obese or nonobese using ICD-9 codes. Outcome variables were 90-day readmission, major medical complication, infection, and revision rates. Data were queried for demographics, comorbidities, surgery characteristics, and outcome variables. Logistic multivariate regression was utilized, serially testing interactions between obesity and other independent variables in separate models for each outcome. The Benjamini-Hochberg procedure was used to adjust statistical significance for multiple comparisons. RESULTS: A total of 262,153 patients were included: 31,062 obese and 231, 091 nonobese. For major complications, obese patients had lower odds ratios (ORs) versus nonobese patients for cerebrovascular accident, diabetes with chronic complications, age ≥65, congestive heart failure, history of myocardial infarction, renal disease, chronic pulmonary disease, Medicare/Medicaid payor, more than two levels fused, transforaminal/posterior lumbar interbody fusion, and female sex, and higher OR for non-White race. For readmission, obese patients had lower OR for age ≥65, history of MI, renal disease, and mental health disease, and higher OR for female sex. For revision, obese patients had higher OR for female sex and TLIF/PLIF. For infection, obese patients had lower OR for diabetes with and without chronic complications, and higher OR for female sex. CONCLUSION: Many medical comorbidities have less impact in obese patients than nonobese patients in predicting adverse outcomes despite increased rates of adverse outcomes in obese patients. These findings reflect the impact of obesity as an independent risk factor and have important implications for preoperative optimization.Level of Evidence: 3.
STUDY DESIGN: Retrospective case-control study. OBJECTIVE: The aim of this study was to determine the influence of obesity on risk factors for adverse outcome after lumbar spine fusion (LSF). SUMMARY OF BACKGROUND DATA: Obesity is risk factor for complications after LSF and poses unique challenges regarding optimization of care. Nonetheless, this patient population is not well-studied. METHODS: Adult patients undergoing LSF were identified the State Inpatient Database. Patients were identified as obese or nonobese using ICD-9 codes. Outcome variables were 90-day readmission, major medical complication, infection, and revision rates. Data were queried for demographics, comorbidities, surgery characteristics, and outcome variables. Logistic multivariate regression was utilized, serially testing interactions between obesity and other independent variables in separate models for each outcome. The Benjamini-Hochberg procedure was used to adjust statistical significance for multiple comparisons. RESULTS: A total of 262,153 patients were included: 31,062 obese and 231, 091 nonobese. For major complications, obesepatients had lower odds ratios (ORs) versus nonobese patients for cerebrovascular accident, diabetes with chronic complications, age ≥65, congestive heart failure, history of myocardial infarction, renal disease, chronic pulmonary disease, Medicare/Medicaid payor, more than two levels fused, transforaminal/posterior lumbar interbody fusion, and female sex, and higher OR for non-White race. For readmission, obesepatients had lower OR for age ≥65, history of MI, renal disease, and mental health disease, and higher OR for female sex. For revision, obesepatients had higher OR for female sex and TLIF/PLIF. For infection, obesepatients had lower OR for diabetes with and without chronic complications, and higher OR for female sex. CONCLUSION: Many medical comorbidities have less impact in obesepatients than nonobese patients in predicting adverse outcomes despite increased rates of adverse outcomes in obesepatients. These findings reflect the impact of obesity as an independent risk factor and have important implications for preoperative optimization.Level of Evidence: 3.
Authors: Michael R Mercier; Anoop R Galivanche; Ryan McLean; Alexander J Kammien; Courtney S Toombs; Daniel R Rubio; Arya G Varthi; Jonathan N Grauer Journal: N Am Spine Soc J Date: 2022-08-13
Authors: Fabio Cofano; Giuseppe Di Perna; Daria Bongiovanni; Vittoria Roscigno; Bianca Maria Baldassarre; Salvatore Petrone; Fulvio Tartara; Diego Garbossa; Marco Bozzaro Journal: Global Spine J Date: 2021-06-15