Rivkin MA and Yocom SS
Study design: Prospective observational study of consecutive patients. Objective: Body Mass Index (BMI) has recently been investigated for its association with adverse events during lumbar fusion surgery and remains a controversial issue. We attempt to evaluate the impact of BMI on the incidence of perioperative complications after elective, degenerative, posterior lumbar fusions in a surgery-naïve population. Methods: We prospectively studied 77 consecutive patients undergoing open posterolateral lumbar fusion procedures at a single tertiary care center. Perioperative adverse events were defined by previously published reports and collected during the inpatient stay. Inclusion criteria reflected patients undergoing elective instrumented lumbar fusions while patients with revision surgery or history of infection, trauma or tumor were excluded from the study. Results: There were 39 non-obese (BMI<30) and 38 obese (BMI>30) patients. Overall, 38% of patients suffered at least one complication. Forty one total complications occurred, 76% of those were minor and 24% were major complications. There was a significant difference in the rate of total complications between two groups with 13 adverse events in non-obese and 28 events in obese group (p=.028). Using a backward elimination multivariate stepwise regression model based on maximum likelihood, obesity was an independent predictor of total complications (p=0.02, OR 1.082, 95% confidence interval 1.012-1.157). Conclusion: Lumbar fusion surgery is one of the most common spinal procedures and continues to be on the rise over the past decade. This prospective evaluation of patients undergoing elective degenerative lumbar fusions correlated obesity with increased incidence of total perioperative complications. These results argue for a more conservative approach and stringent surgical selection in obese patients.
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