Critical care of obese patients during and after spine surgery

Abstract

Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes.

Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion

“…[17][18][19][20][21][22][23] Furthermore, morbidly obese patients tend to have poorer quality of preoperative imaging, increased difficulty during the surgical approach due to excess subcutaneous fat deposits, and enhanced difficulty in intraoperative anesthetic management. 14,24,25 Not surprisingly, many studies have shown a significantly higher rate of perioperative complications in morbidly obese patients. 15,26,27 Recent advances in anesthetic and surgical management, however, have made PLF an increasingly viable and safe option for morbidly obese patients, and the rate of spinal surgery in this patient population has risen in recent years.…”

A prospective cohort study of the accuracy and safety of robot-assisted minimally invasive spinal surgery

“…Additionally, one patient in the RA-MIS group underwent postoperative expansion surgery compared with none in the RA-OS group. This may be related to wound infection caused by the patient's second-degree obesity (BMI = 31.25) [5].…”

Intraoperative neurophysiological monitoring of T9-T10 fracture in a patient with morbid obesity and ankylosing spondylitis: A case report with literature review

“…With the increasing frequency of spine surgery for patients with morbid obesity, it is important to elucidate appropriate treatment practices to reduce the risk of iatrogenic injury. Bariatric security straps can comfortably control a large abdominal pannus on the Jackson table, allowing for passage of fluoroscopy ( Elgafy et al, 2016 ). Although they were not used in this case, bariatric straps may relieve additional pressure on the anterior spine for such patients, reducing the risk of perioperative complication.…”