Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

Rudy, Hayeem L.; Cho, Woojin; Oster, Brittany A.; Tarpada, Sandip P.; Moran-Atkin, Erin

doi:10.31616/asj.2019.0236

Cited by 6 publications

(3 citation statements)

References 25 publications

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“…The extent and speed of weight loss may be another consideration when counseling patients before spine surgery. A >10% loss in body weight over 6 months before spine surgery has been shown to be associated with worse clinical outcomes such as DVT, increased incidence of blood transfusions, higher organ/space surgical site infections, and increased hospital length of stay 21. Therefore, a history of rapid weight loss before spine surgery in patients who have undergone BS could predispose these patients to a higher risk of readmission, reoperation, and all-cause complications.…”

Section: Discussionmentioning

confidence: 99%

Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications

Gupta

Tao

Matur

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis investigating the rate of adverse events after spine surgery in patients who underwent bariatric surgery (BS). Summary of Background Data. Obesity is an established risk factor for postoperative complications after spine surgery. BS has been associated with improvements in health in patients with severe obesity. However, it is not known whether undergoing BS before spine surgery is associated with reduced adverse outcomes. Materials and Methods. PubMed, EMBASE, Scopus, and Web-of-Science were systematically searched according to “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines. The search included indexed terms and text words from database inception to the date of the search (May 27, 2022). Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. The primary outcome was an all-cause complication rate after surgery. Relative risks for surgical and medical complications were assessed. Results. A total of 4 studies comprising 177,273 patients were included. The pooled analysis demonstrated that the all-cause medical complication rate after spine surgery was lower in patients undergoing BS (relative risk: 0.54, 95% CI: 0.39, 0.74, P < 0.01). There was no difference in rates of surgical complications and 30-day hospital readmission rates between the cohort undergoing BS before spine surgery and the cohort that did not. Conclusion. These analyses suggest that obese patients undergoing BS before spine surgery have significantly lower adverse event rates. Future prospective studies are needed to corroborate these findings. Level of Evidence. 4.

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Section: Discussionmentioning

confidence: 99%

Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications

Gupta

Tao

Matur

et al. 2023

Spine

View full text Add to dashboard Cite

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“…Based on our sensitivity analysis results, we feel that while our model did not specifically capture a patient with a BMI more than 35, such a patient would benefit even more from preoperative bariatric surgery prior to elective outpatient surgery. Jensen et al 20 reported that patients with a history of bariatric surgery fared worse than those without while Rudy et al 21 have recently published work demonstrating that rapid weight loss within 6 months of elective lumbar surgery led to increased postoperative complications. However, the optimal waiting period following bariatric surgery and prior to elective lumbar surgery remains unknown.…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of Bariatric Surgery Prior to Posterior Lumbar Decompression and Fusion in an Obese Population with Degenerative Spondylolisthesis

Paranjape

Gentry

Regan

2021

Spine

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Study Design. Cost-effectiveness analysis. Objective. To determine if bariatric surgery prior to posterior lumbar decompression and fusion (PLDF) for degenerative spondylolisthesis (DS) is a cost-effective strategy. Summary of Background Data. Obesity poses significant perioperative challenges for DS. Treated operatively, obese patients achieve worse outcomes relative to non-obese peers. Concomitantly, they fare better with surgery than with nonoperative measures. These competing facts create uncertainty in determining optimal treatment algorithms for obese patients with DS. The role of bariatric surgery merits investigation as a potentially cost-effective optimization strategy prior to PLDF. Methods. We simulated a Markov model with two cohorts of obese individuals with DS. 10,000 patients with body mass index (BMI) more than or equal to 30 in both arms were candidates for both bariatric surgery and PLDF. Subjects were assigned either to (1) no weight loss intervention with immediate operative or nonoperative management (''traditional arm'') or (2) bariatric surgery 2 years prior to entering the same management options (''combined protocol''). Published costs, utilities, and transition probabilities from the literature were applied. A willingness to pay threshold of $100,000/QALY was used. Sensitivity analyses were run for all variables to assess the robustness of the model. Results. Over a 10-year horizon, the combined protocol was dominant ($13,500 cheaper, 1.15 QALY more effective). Changes in utilities of operative and nonoperative treatments in non-obese patients, the obesity cost-multiplier, cost of bariatric surgery, and the probability of success of nonoperative treatment in obese patients led to decision changes. However, all thresholds occurred outside published bounds for these variables. Conclusion. The combined protocol was less costly and more effective than the traditional protocol. Results were robust with thresholds occurring outside published ranges. Bariatric surgery is a viable, cost-effective preoperative strategy in obese patients considering elective PLDF for DS.

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“…Among patient demographics, comorbidities and obesity are known to be significant risk factors for increasing perioperative blood loss. [12][13][14][15][16][17][18] Therefore, in this study, various factors such as obesity, use of medical drugs, and comorbidities were also evaluated.…”

Section: Introductionmentioning

confidence: 99%

Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group

Jang

Park

Kim

et al. 2021

Global Spine Journal

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Study Design: A retrospective case-control study. Objectives: The usefulness of a drain in spinal surgery has always been controversial. The purposes of this study were to determine the incidence of hematoma-related complications after posterior lumbar interbody fusion (PLIF) without a drain and to evaluate its usefulness. Methods: We included 347 consecutive patients with degenerative lumbar disease who underwent single- or double-level PLIF. The participants were divided into 2 groups by the use of a drain or not; drain group and no-drain group. Results: In 165 cases of PLIF without drain, there was neither a newly developed neurological deficit due to hematoma nor reoperation for hematoma evacuation. In the no-drain group, there were 5 (3.0%) patients who suffered from surgical site infection (SSI), all superficial, and 17 (10.3%) patients who complained of postoperative transient recurred leg pain, all treated conservatively. Days from surgery to ambulation and length of hospital stay (LOS) of the no-drain group were faster than those of the drain group ( P < 0.001). In a multiple regression analysis, a drain insertion was found to have a significant effect on the delayed ambulation and increased LOS. No significant differences existed between the 2 groups in additional surgery for hematoma evacuation, or SSI. Conclusions: No hematoma-related neurological deficits or reoperations caused by epidural hematoma and SSI were observed in the no-drain group. The no-drain group did not show significantly more frequent postoperative complications than the drain use group, hence the routine insertion of a drain following PLIF should be reconsidered carefully.

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Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

Cited by 6 publications

References 25 publications

Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications

Bariatric Surgery Before Spine Surgery is Associated with Fewer Post-Surgical Complications

Cost-Effectiveness of Bariatric Surgery Prior to Posterior Lumbar Decompression and Fusion in an Obese Population with Degenerative Spondylolisthesis

Is Routine Use of Drain Really Necessary for Posterior Lumbar Interbody Fusion Surgery? A Retrospective Case Series with a Historical Control Group

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