Original Study

Effect of body mass index on patient outcomes of surgical intervention for the lumbar spine

Michael Flippin, Jessica Harris, Elizabeth W. Paxton, Heather A. Prentice, Donald C. Fithian, Samuel R. Ward, Sara P. Gombatto


Background: Conflicting findings exist on the effect of obesity on outcomes of lumbar spine surgery; results depend on the diagnosis studied, procedure evaluated, definition of obesity, and specific outcomes measured. The purpose of this retrospective cohort study is to examine the effect of increasing body mass index (BMI) on surgical-related, health-related, and long-term outcomes of lumbar spine surgery in a single representative patient sample.
Methods: Using a surgical registry from an integrated health care system, 8,049 instrumented lumbar spine cases were identified between 1/1/2009 and 09/30/2013. The sample was stratified into five BMI categories. Outcomes of interest included: (I) surgical-related factors and complications; (II) health-related complications; and (III) long-term complications. Mixed linear models, conditional logistic regressions, and survival analysis using a Cox regression model were conducted controlling for surgeon effects. Age, gender, diabetes status, smoking status, admitting diagnosis, and surgical approach were included as covariates.
Results: Every 5 kg/m2increase in BMI was associated with a significant increase in surgical time (7.8 minutes), estimated blood loss (EBL) (36.5 mL), risk of deep infection (OR =1.7 times), and deep vein thrombosis (DVT) (OR =1.5). BMI was not associated with increased incidence of other intraoperative or health-related complications. Rate of re-operation was 1.1 times higher with every 5 kg/m2increase in BMI, but rate of re-operation due to adjacent segment disease (ASD) was not associated with BMI.
Conclusions: Obesity had an adverse effect on certain surgical-related, health-related and long-term surgical outcomes. The magnitude of this effect increased with increasing levels of obesity, which increases the medical burden associated with obesity.

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