Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery

Ottesen, Taylor D.; Malpani, Rohil; Galivanche, Anoop R.; Zogg, Cheryl K.; Varthi, Arya G.; Grauer, Jonathan N.

doi:10.1016/j.spinee.2020.03.007

Cited by 21 publications

(27 citation statements)

References 32 publications

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“…Being underweight may increase the risk of postoperative complications in patients undergoing surgery as shown in previous studies [ 31 , 32 ]. Nevertheless, evidence is still missing regarding the risks of breast reconstruction in underweight patients.…”

Section: Discussionmentioning

confidence: 94%

BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

Leitner

Pauzenberger

Ederer

et al. 2021

JCM

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Background: Breast reconstruction has a positive impact on body image and quality of life for women after experiencing the physically and psychologically demanding process of mastectomy. Previous studies have presented body mass index (BMI) as a predictor for postoperative complications after breast reconstruction, however, study results vary. This retrospective study aimed to investigate the impact of patients’ BMI on postoperative complications following implant-based breast reconstruction. Methods: All implant-based breast reconstructions performed at the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna from January 2001 to March 2018 were evaluated. A total of 196 reconstructed breasts among 134 patients met eligibility criteria. Demographic data, surgical techniques, as well as major and minor complications within a one-year follow-up period were analyzed. Results: Patients’ BMI did not show a significant impact on complication rates. The overall incidence of postoperative complications was 30.5% (40/131) of which 17.6% required reoperation. Impaired wound healing (18.3%), seroma (6.1%), hematoma (4.6%), capsular contraction (4.6%) and infection (3.8%) were the most common complications. Conclusion: In our study cohort, BMI was not associated with a significantly higher risk of complications. However, postoperative complications significantly increased with a longer operative time and resulted in an extended length of hospital stay.

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Section: Discussionmentioning

confidence: 94%

BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

Leitner

Pauzenberger

Ederer

et al. 2021

JCM

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“…Body mass index (BMI) was calculated based on weight and height. The ASA classification provided a marker for general health status as has been done in prior studies, [28] , [29] , [30] , [31] , [32] , [33] with diabetes 34 and smoking as additional variables to control.…”

Section: Methodsmentioning

confidence: 99%

Perioperative adverse events after different fusion approaches for single-level lumbar spondylosis

Gala

Ottesen

Kahan

et al. 2020

North American Spine Society Journal (NASSJ)

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Background: Low back pain from lumbar spondylosis affects a large proportion of the population. In select cases, lumbar fusion may be considered. However, cohort studies have not shown clear differences in long-term outcomes between PSF, TLIF, ALIF, and AP fusion. Thus, differences in perioperative complications might affect choice between these procedures for the given diagnosis. The current study seeks to compare perioperative adverse events for patients with lumbar spondylosis treated with single-level: posterior spinal fusion (PSF), transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), or combined anterior and posterior lumbar fusion (AP fusion).Methods: Patients with a diagnosis of lumbar spondylosis who underwent single-level lumbar fusion without decompression were identified in the 2010-2016 National Quality Improvement Program (NSQIP) database. Patients were categorized based on their procedure (PSF, TLIF, ALIF, or AP fusion). Unadjusted Fisher's exact and Pearson's chi-squared tests were used to compare demographics and comorbid factors. Analysis was secondarily done with propensity score matching to address potential differences in patient selection between the study cohorts.Results: In total, 1816 patients were identified: PSF n = 322, TLIF n = 800, ALIF n = 460, AP fusion n = 234. The procedures did not have different thirty-day individual or aggregated (any, serious, minor, or infection) adverse events. Further, propensity score matched analysis also revealed no differences in individual or aggregated thirtyday perioperative events. Conclusion:The current study demonstrates a lack of difference in thirty-day perioperative adverse events for different fusion procedures performed for lumbar spondylosis, consistent with prior longer-term outcome studies. These findings suggest that patient/surgeon preference and other factors not captured here should be considered to determine the best surgical technique for the select patients with the given diagnosis who are considered for lumbar fusion.

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“…Body mass index, defined as weight/height 2 , was calculated from recorded height (m) and weight (kg) and then cases were then binned into six different BMI group categories as outlined by the World Health Organization. These were: underweight (BMI < 18.5 kg/m 2) , normal weight (BMI of 18.5-24.9 kg/m 2) , overweight (BMI 25.0-29.9 kg/m 2) , obese (BMI of greater than 30.0-39.9 kg/m 2) , morbidly obese (BMI of greater than 40.0-49.9 kg/m 2) , and super morbidly obese (BMI > 50.0 kg/m 2) [18] .…”

Section: Patient/surgical Characteristicsmentioning

confidence: 99%

Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery

Ottesen

Bagi

Malpani

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: Body Mass Index (BMI) is a weight-for-height metric that is used to quantify tissue mass and weight levels. Past studies have mainly focused on the association of high BMI on spine surgery outcomes and shown variable conclusions. Prior results may have varied due to insufficient power or inconsistent categorical separation of BMI groups (e.g. underweight, overweight, or obese). Additionally, few studies have considered outcomes of patients with low BMI. The aim of the current study was to analyze patients along the entirety of the BMI spectrum and to establish specific granular BMI categories for which patients become at risk for complication and mortality following posterior cervical spine surgery.Methods: Patients undergoing elective posterior cervical spine surgery were abstracted from the 2005-2016 National Surgical Quality Improvement Program (NSQIP) databases. Patients were aggregated into pre-established WHO BMI categories and adverse outcomes were normalized to average risk of normal-weight subjects (BMI 18.5-24.9 kg/m 2 ). Risk-adjusted multivariate regressions were performed controlling for patient demographics and overall health.Results: A total of 16,806 patients met inclusion criteria. Odds for adverse events for underweight patients (BMI < 18.5 kg/m 2 ) were the highest among any category of patients along the BMI spectrum. These patients experienced increased odds of any adverse event (Odds Ratio (OR) = 1.67, p = 0.008, major adverse events (OR = 2.08, p = 0.001), post-operative infection (OR = 1.95, p = 0.002), and reoperation (OR = 1.84, p = 0.020). Interestingly, none of the overweight or obese categories were found to be correlated with increased risk of adverse event categories other than super-morbidly obese patients (BMI > 50.0 kg/m 2 ) for post-operative infection (OR = 1.54, p = 0.041). Conclusions:The current study found underweight patients to have the highest risk of adverse events after posterior cervical spine surgery. Increased pre-surgical planning and resource allocation for this population should be considered by physicians and healthcare systems, as is often already done for patients on the other end of the BMI spectrum.

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Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery

Cited by 21 publications

References 32 publications

BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

BMI Specific Complications Following Implant-Based Breast Reconstruction after Mastectomy

Perioperative adverse events after different fusion approaches for single-level lumbar spondylosis

Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery

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