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

Abstract

Study Design:Retrospective cohort study.Objectives:The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regarding additional risk factors that further predispose this already high-risk patient population to poor surgical outcomes following elective posterior lumbar fusion (PLF). The aim of the study is to identify independent risk factors for poor 30-day perioperative outcomes in morbidly obese patients undergoing elective PLF.Methods:We identified 22 909 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective PLF. There were 1861 morbidly obese patients. Baseline patient demographics and medical comorbidities were collected. Univariate analysis was performed to compare perioperative complication rates between non-morbidly obese and morbidly obese patients. The 5 most common complications in the morbidly obese group were then selected for multivariate regression analysis to identify independent risk factors for poor 30-day outcomes.Results:Morbidly obese patients had a higher perioperative complication rate. The 5 most common complications were prolonged hospitalization, blood transfusion, readmission, wound complications, and reoperation. Independent risk factors for these complications were age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4 levels, and extended operative time (ie, operative time ≥318 minutes).Conclusions:Morbidly obese patients are at higher risk of perioperative complications following elective PLF. Modifiable risk factors for the most common complications are obesity and preoperative steroid use.

The impact of long-term corticosteroid use on acute postoperative complications following lumbar decompression surgery

“…Similar to our findings, Ranson et al demonstrated that patients with long term corticosteroid use undergoing posterior lumbar fusion were at a 2.15 times risk of pulmonary embolism (p ¼ 0.0295). 22 This is similar to the data reported in the literature, seen among non-orthopedic and orthopedic surgical fields. 15,30e35 However, despite these findings, the exact mechanism connecting the two remains unknown.…”

“…21 Ranson et al also demonstrated an increased risk of UTI in patients undergoing posterior lumbar fusion. 22 Cloney et al also reported increased rate of UTI in the long-term corticosteroid use group versus control in patients undergoing posterior lumbar fusion (4.0% vs 2.0%, respectively, p ¼ 0.002). 13 Furthermore, infections originating from the urogenital tract have been shown to be one of the most common sources of infection leading to sepsis and septic shock, accounting for 20e30% of all septic patients.…”

Anaesthesia for the obese patient

“…Age !65 yrs was found to be an independent risk factor for postoperative complications in Class 3 obese patients undergoing posterior lumbar fusion. 4 The development of severe lifethreatening complications after bariatric surgery was not linked to age in another study. Overall mortality was increased more than three-fold in those aged !55 yrs compared with those aged <55 yrs, suggesting that the older group were less able to recover from complications.…”

Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches?

“…Specifically, 729 papers were duplicated, while 732 articles were found to have irrelevant title. Moreover, 45 articles were excluded after reading since they did not meet the inclusion 124 Retrospective study 2 Kukreja et al, 2015 51 Retrospective study 2 Lingutla et al, 2015 30 Meta-analysis 1 Nota SP et al, 2015 125 Retrospective study 2 Ou et al, 2015 10 Retrospective study 2 Planchard RF et al, 2015 126 Retrospective study 2 Retrospective study 2 96 Mcclendon et al, 2014 16 Retrospective study 2 97 McGuire KJ et al, 2014 132 Prospective study 1 98 Pereira BJ et al, 2014 133 Retrospective study 2 99 Quah C et al, 2014 134 Retrospective study 2 100 Seicean A et al, 2014 135 Retrospective cohort study 3 101 Srinivasan et al, 2014 136 Retrospective study 2 102 Terman et al, 2014 28 Retrospective cohort study 3 103 Wang J et al, 2014 137 Prospective study 1 104 Lau, Khan et al, 2013 27 Retrospective study 2 105 Lau, Ziewacz et al, 2013 52 Retrospective study 2 106 Rihn JA et al, 2013 138 Retrospective study 2 107 Rosenfeld HE et al, 2013 139 Case series 4 108 Gaudelli C et al, 2012 140 Retrospective cohort study 3 109 Kalanithi et al, 2012 17 Retrospective study 2 110 Mehta AI et al, 2012 141 Retrospective study 2 111…”