The impact of chronic obstructive pulmonary disease and obesity on length of stay and cost of spine surgery

Abstract

Background:Chronic obstructive pulmonary disease (COPD) and obesity may be more common among spine surgery patients than in the general population and may affect hospital cost.Materials and Methods:We retrospectively studied the prevalence of COPD and obesity among 605 randomly selected spine surgery inpatients operated between 2005 and 2008, including lumbar microdiskectomy, anterior cervical decompression and fusion and lumbar decompression and fusion patients. The length of hospital stay and hospital charges for patients with and without COPD and obesity (body mass index [BMI]≥30 kg/m2) were compared.Results:Among 605 spine surgery patients, 9.6% had a history of COPD. There were no statistical difference in the prevalence of COPD between the three spine surgery groups. Obesity was common, with 47.4% of the patients having a BMI≥30 kg/m2. There were no significant differences in obesity rates or BMI values between the three types of spine surgery patients. Obesity rates between patients with and without COPD were 62.1% vs. 45.9%, and were statistically different (P<0.05). Similarly, significant difference (P<0.01) in BMI values between COPD and non-COPD groups, 32.66±7.19 vs. 29.57±6.048 (mean ± std. deviation), was noted. There was significant difference (P<0.01) in cost between nonobese female patients without COPD and those with obesity and COPD in the anterior cervical decompression and fusion (ACDF) group. No association with increased hospital length of stay or cost was found in the other two types of spine surgery or in male ACDF patients.Conclusion:COPD and obesity seem to additively increase the length of hospital stay and hospital charges in ACDF female patients, an important finding that requires further investigation.

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

“…on overall costs and found additive increases with cost and comorbid conditions. 23 24 Therefore, a greater prevalence of comorbid conditions, as seen in our obese cohort, could be driving the residual difference demonstrated on multivariate analysis.…”

Using the ACS-NSQIP to Identify Factors Affecting Hospital Length of Stay After Elective Posterior Lumbar Fusion

“…9 Walid et al also found that obesity was associated with increased length of stay after spine surgery. 13 …”

“…Previous studies have described individual factors that contribute to increased length of stay after spine surgery, such as morbid obesity, 8 metabolic syndrome, 9 black race, 10 open surgery versus minimally invasive surgery, 11 age, 12 chronic obstructive pulmonary disease (COPD), 13 antidepressant use, 14 unemployment, 15 chronic renal disease, 15 and intraoperative fluid volume. 16 However, these were generally small studies that examined isolated factors, leaving significant room for the effects of confounding variables.…”

Preoperative Factors Affecting Length of Stay After Elective Anterior Cervical Discectomy and Fusion With and Without Corpectomy

“…History of pulmonary disease was also found to be significantly associated with extended LOS after ACDF in studies by Harris et al 12 and Walid et al 17 Pulmonary disease such as COPD or asthma could affect LOS by increasing postoperative care requirements and/or the risk of postoperative pulmonary complications. 18 …”

“…8–10,12,17 Differences between studies are most likely due to inclusion of different predictive factors in the multivariate models of other studies (such as intraoperative and postoperative factors), differences in inclusion criteria or populations studied, and differences in surgical technique and discharge criteria. The fact that findings can differ so greatly between studies underlines the importance of using multiple patient samples, drawn from different populations, in order to best characterize factors affecting LOS after ACDF.…”