The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion

Villavicencio, Alan T.; Nelson, E. Lee; Rajpal, Sharad; Vivek, Niketna; Burneikienė, Sigita

doi:10.1016/j.clineuro.2019.02.012

Cited by 22 publications

(12 citation statements)

References 27 publications

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“…However, overly high BMI is associated with adverse effects, as overweight patients have a higher incidence of low-back pain and spinal disease requiring multiple surgeries (25,26). Obesity, de ned as a BMI of ≥ 30 kg/m 2 , is closely related to longer hospitalization and greater intraoperative blood loss in patients undergoing spinal fusion surgery, indicating that an overly high BMI may cause greater perioperative blood loss in patients with STB (27). In our study, a BMI within 19.5-30 kg/m 2 was determined to be bene cial in preventing PMA in patients with STB.…”

Section: Clinical Ndings: Diabetes Mellitus and Bmimentioning

confidence: 69%

Adequate preoperative hemoglobin level in patients with thoracic and lumbar tuberculosis: A single center retrospective cohort study

Jiang

Zhang

et al. 2022

Preprint

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Objective This study aimed to find out the risk factors of postoperative moderate anemia (PMA) to develop a scoring scale for predicting the occurrence of PMA and to determine the recommended preoperative hemoglobin level in spinal tuberculosis (STB) patients. Methods A total of 223 STB patients who underwent focus debridement from January 2012 to March 2020 were enrolled in the study. The study cohort was divided into two groups owing to the occurrence of PMA. Moderate anemia was defined as a hemoglobin level of < 90 g/L. The clinical characteristics of STB patients who developed PMA were evaluated, and a scale was developed by logistic regression analysis. The performance of this scoring scale is prevalidated. Results Of the 223 patients, 76 developed PMA. Multivariate binary logistic regression analysis showed that body mass index, diabetes, low preoperative hemoglobin level, long operation time, and posterior approach were independent risk factors for PMA in STB patients. These significant items were assigned scores to create a scoring scale as to predicting PMA, and receiver operating characteristic (ROC) curve analysis implicated that the optimal cutoff score was 4 points. On the basis of the scoring scale, patients with scores within 0–3 points were defined as the low-risk group; those with scores within 4–6 points were defined as the moderate-risk group; and those with scores within 7–10 points were defined as the high-risk group. The perioperative decrease in hemoglobin level was 20.07 ± 10.47 g/L in the low-risk group, 24.44 ± 12.67 g/L in the moderate-risk group, and 29.18 ± 10.34 g/L in the high-risk group. Conclusion According to the scoring scale, patients with STB with a score of 0–3 points have a low risk of PMA, those with a score of 4–6 have a moderate risk, and those with a score of 7–10 have a high risk. The recommended preoperative hemoglobin levels for the low-, moderate-, and high-risk groups are 110, 115, and 120 g/L, respectively.

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Section: Clinical Ndings: Diabetes Mellitus and Bmimentioning

confidence: 69%

Adequate preoperative hemoglobin level in patients with thoracic and lumbar tuberculosis: A single center retrospective cohort study

Jiang

Zhang

et al. 2022

Preprint

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“…Indirect decompression of the spinal canal, then without the need for artrectomy and laminectomy could be considered as a powerful weapon in obese patients because of the reduced need for muscle dissection, surgical trauma and, subsequently, blood loss. 83 , 86 …”

Section: Discussionmentioning

confidence: 99%

“…However, while obesity did not result to affect surgical outcomes in lumbar stenosis, it was found to be associated with higher risks for infection, re-operation rate and lower improvement in SF-36 physical score, when surgery was performed for degenerative spondylolisthesis 142 ; less improvement in Oswestry Disability Index (ODI) scale and SF-36 physical score was similarly reported for inter-vertebral disc herniation from the Trial. 138 121 Retrospective study 16 Safaee MM et al, 2020 70 Retrospective study 81 Cao J et al, 2015 122 Meta-analysis 17 Siccoli A et al, 2020 71 Retrospective study 82 De la Garza Ramos et al, 2015 32 Retrospective study 19 Xi Z et al, 2020 73 Retrospective study 83 Giannadakis C et al, 2015 123 Prospective study 24 Goyal Additionally, McGuire et al reported a sub-group analysis from the SPORT trial highlighting higher rate of wound infections and longer operative time for class II and III obese patients (highly obese) compared to class I obese patients. Moreover, although highly obese patients reported worst outcomes compared with class I obeses, especially when surgery was performed for disc herniation, surgical treatment resulted able to provide better outcomes when compared with nonsurgical treatment.…”

Section: Obesity and Lumbar Spine Surgerymentioning

confidence: 99%

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

Cofano

Perna

Bongiovanni

et al. 2021

Global Spine Journal

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Study Design: Literature review. Objectives: An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. Methods: Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. Results: A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). Conclusion: Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.

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“…They also have an increased risk of readmission due to revision surgery and postoperative complications. 7 , 9 , 10 …”

Section: Introductionmentioning

confidence: 99%

Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis

Chen¹,

Lin²,

Rui³

et al. 2022

JPR

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Purpose Previous studies have demonstrated that minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is comparable to the open approach in terms of efficacy and safety. However, few comparative studies of surgical procedures in patients with obesity show that they may react differently to open-TLIF (O-TLIF) and MI-LTIF approaches. Patients and Methods The main indicators were complications, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score, and secondary indicators were operative time, blood loss, and hospital stay. Results No significant differences in the VAS and ODI scores for back pain at the last follow-up and wound infection rates were observed between the two groups. Dural tear incidence and complication rate were significantly lower in the MI-TLIF group than that in the O-TLIF group (P = 0.002 and 0.001, respectively). No significant difference in operative time was found between the two groups. There was less blood loss and shorter hospital stay (P = 0.001 and 0.002, respectively) in the MI-TLIF group than that in the O-TLIF group. Conclusion Compared with O-TLIF, MI-TLIF is an effective and safe surgical option for patients with obesity, which resulted in similar improvements in pain and functional disability, as well as a lower complication rate.

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The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion

Cited by 22 publications

References 27 publications

Adequate preoperative hemoglobin level in patients with thoracic and lumbar tuberculosis: A single center retrospective cohort study

Adequate preoperative hemoglobin level in patients with thoracic and lumbar tuberculosis: A single center retrospective cohort study

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

Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis

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