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Body mass index as a predictor of complications and mortality after lumbar spine surgery.
Spine (Phila Pa 1976). 2014 May 01; 39(10):798-804.S

Abstract

STUDY DESIGN

Retrospective analysis.

OBJECTIVE

A national population-based database was analyzed to characterize the risks of postoperative complications and mortality associated with the patient's body mass index (BMI) after lumbar spinal surgery.

SUMMARY OF BACKGROUND DATA

Obesity has been associated with greater perioperative complications and worsened surgical outcomes after lumbar spinal surgery. However, the stratified BMI risks of postoperative complications relative to normal weight patients have not been well characterized.

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent lumbar spinal surgery between 2006 and 2011. Patients were stratified into BMI cohorts: normal (18.5-24.99 kg/m), overweight (25.00-29.99 kg/m), class 1 (30.00-34.99 kg/m), class 2 (35.00-39.99 kg/m), and class 3 (≥40 kg/m) obesity. Preoperative patient characteristics and perioperative outcomes were assessed. The relative risks of 30-day postoperative complications and mortality for each BMI cohort were calculated in reference to the normal weight cohort using a 95% confidence interval.

RESULTS

A total of 24,196 patients underwent lumbar spine surgery between 2006 and 2011 of which 19,195 (79.3%) were overweight or obese. The risk for deep vein thrombosis increased beginning with overweight patients and compounded for the subsequent obesity classes. The risk for superficial wound infection and pulmonary embolism increased beginning with the class 1 obesity cohort. Furthermore, the relative risk increase for urinary tract infection, acute renal failure, and sepsis was significantly increased only among class 3 obesity patients. Lastly, there was no relative risk increase in 30-day mortality in any cohort after lumbar spine surgery.

CONCLUSION

Overweight and obese patients demonstrated an increased risk of postoperative complications relative to normal weight patients. Despite these findings, a BMI 25 kg/m or more was not associated with a greater risk of mortality. Further studies are warranted to characterize the impact of postoperative complications associated with overweight and obese patients on hospital resource utilization and costs after lumbar spine surgery.

Authors+Show Affiliations

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24480950

Citation

Marquez-Lara, Alejandro, et al. "Body Mass Index as a Predictor of Complications and Mortality After Lumbar Spine Surgery." Spine, vol. 39, no. 10, 2014, pp. 798-804.
Marquez-Lara A, Nandyala SV, Sankaranarayanan S, et al. Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine. 2014;39(10):798-804.
Marquez-Lara, A., Nandyala, S. V., Sankaranarayanan, S., Noureldin, M., & Singh, K. (2014). Body mass index as a predictor of complications and mortality after lumbar spine surgery. Spine, 39(10), 798-804. https://doi.org/10.1097/BRS.0000000000000232
Marquez-Lara A, et al. Body Mass Index as a Predictor of Complications and Mortality After Lumbar Spine Surgery. Spine. 2014 May 1;39(10):798-804. PubMed PMID: 24480950.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body mass index as a predictor of complications and mortality after lumbar spine surgery. AU - Marquez-Lara,Alejandro, AU - Nandyala,Sreeharsha V, AU - Sankaranarayanan,Sriram, AU - Noureldin,Mohamed, AU - Singh,Kern, PY - 2014/2/1/entrez PY - 2014/2/1/pubmed PY - 2015/2/24/medline SP - 798 EP - 804 JF - Spine JO - Spine VL - 39 IS - 10 N2 - STUDY DESIGN: Retrospective analysis. OBJECTIVE: A national population-based database was analyzed to characterize the risks of postoperative complications and mortality associated with the patient's body mass index (BMI) after lumbar spinal surgery. SUMMARY OF BACKGROUND DATA: Obesity has been associated with greater perioperative complications and worsened surgical outcomes after lumbar spinal surgery. However, the stratified BMI risks of postoperative complications relative to normal weight patients have not been well characterized. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent lumbar spinal surgery between 2006 and 2011. Patients were stratified into BMI cohorts: normal (18.5-24.99 kg/m), overweight (25.00-29.99 kg/m), class 1 (30.00-34.99 kg/m), class 2 (35.00-39.99 kg/m), and class 3 (≥40 kg/m) obesity. Preoperative patient characteristics and perioperative outcomes were assessed. The relative risks of 30-day postoperative complications and mortality for each BMI cohort were calculated in reference to the normal weight cohort using a 95% confidence interval. RESULTS: A total of 24,196 patients underwent lumbar spine surgery between 2006 and 2011 of which 19,195 (79.3%) were overweight or obese. The risk for deep vein thrombosis increased beginning with overweight patients and compounded for the subsequent obesity classes. The risk for superficial wound infection and pulmonary embolism increased beginning with the class 1 obesity cohort. Furthermore, the relative risk increase for urinary tract infection, acute renal failure, and sepsis was significantly increased only among class 3 obesity patients. Lastly, there was no relative risk increase in 30-day mortality in any cohort after lumbar spine surgery. CONCLUSION: Overweight and obese patients demonstrated an increased risk of postoperative complications relative to normal weight patients. Despite these findings, a BMI 25 kg/m or more was not associated with a greater risk of mortality. Further studies are warranted to characterize the impact of postoperative complications associated with overweight and obese patients on hospital resource utilization and costs after lumbar spine surgery. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/24480950/Body_mass_index_as_a_predictor_of_complications_and_mortality_after_lumbar_spine_surgery_ L2 - http://dx.doi.org/10.1097/BRS.0000000000000232 DB - PRIME DP - Unbound Medicine ER -