1
|
Goheer HE, Hendrix CG, Samuel LT, Newcomb AH, Carmouche JJ. Obesity is an Independent Risk Factor for Postoperative Pulmonary Embolism after Anterior Cervical Discectomy and Fusion. Spine J 2024:S1529-9430(24)01039-8. [PMID: 39341574 DOI: 10.1016/j.spinee.2024.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 09/09/2024] [Accepted: 09/20/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND Over the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database. PURPOSE The purpose of this study was to analyze obesity level's influence on peri-operative complication rates in patients undergoing ACDF. STUDY DESIGN/SETTING A retrospective cohort, large multicenter database study. PATIENT SAMPLE The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551. OUTCOME MEASURES Medical and surgical complications within thirty days of operation. METHODS Patients were categorized into four BMI groups: non-obese (BMI 18.5-29.9 kg/m2), obese class I (BMI 30-34.9 kg/m2), obese class II (BMI 35-39.9 kg/m2), and obese class III (BMI ≥40 kg/m2). A univariate analysis conducted for demographic variables and pre-operative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to non-obese patients. RESULTS 64,718 patients were identified of whom 33,365 were non-obese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs 0.24%, p = 0.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 versus 0.15%, p = 0.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs 0.4%, p < 0.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129-2.599); OR: 2.213, 95% CI (1.349-2.3.559); OR: 2.207, 95% CI (1.190-3.892), respectively). CONCLUSIONS Risk for post-operative PEs after an ACDF was significantly higher for obese classes I-III compared to non-obese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.
Collapse
Affiliation(s)
- Haseeb E Goheer
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, Virginia, 24016, United States of America
| | - Christopher G Hendrix
- Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, Virginia, 24014, United States of America
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, Virginia, 24014, United States of America; Department of Orthopaedic Surgery, Larkin Community Hospital, 7031 SW 62nd Avenue, Miami, FL, 33143, United States of America
| | - Alden H Newcomb
- Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, Virginia, 24014, United States of America
| | - Jonathan J Carmouche
- Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, Virginia, 24016, United States of America; Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, Virginia, 24014, United States of America.
| |
Collapse
|
2
|
Mukherjee RN, Pandey K, Kumar AG, Phalak M, Borkar S, Garg K, Chandra SP, Kale SS. Comparison of functional outcomes and patient satisfaction in patients with lumbar canal stenosis with and without concomitant obesity following lumbar decompression surgery and their correlation with BMI. J Clin Neurosci 2024; 129:110840. [PMID: 39293321 DOI: 10.1016/j.jocn.2024.110840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Accepted: 09/08/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Obesity is an important predictor of development of Lumbar canal stenosis (LCS) and its symptoms. LCS further restricts the mobility of the patient and a vicious cycle develops. The operative decision on patients with LCS and obesity is a matter of debate. Hence, we attempted to compare changes in body mass index and patient satisfaction in patients with LCS with and without concomitant obesity, undergoing spinal decompression surgery. METHODS Patients undergoing decompression for LCS between 1st June 2019 to 31st May 2020 were included. Baseline characteristics including age, sex, co-morbidities, BMI, self-recorded maximal walking distance (SR-MWD) and Oswestry disability index score (ODI) were recorded. All patients were followed up prospectively at 1 year post surgery. Satisfaction was recorded on a five-point Likert scale. Participants were classified into non obesity (group 1) and obesity (group 2) groups according to JAPI and WHO classification and compared. RESULTS 55 patients met the inclusion criteria, 23 in group 1 and 32 in group 2. Group 2 showed a mean decrease in BMI of 0.95 ± 1.32 kg/m2 while other group had an increase of 0.14 ± 1.31 kg/m2 (p = 0.021). Significant weight change was seen in 31.3 % group 2 vs 8.7 % group 1 patients which was significant (p = 0.046). Pre operative BMI positively correlated with change in BMI after surgery (r = 0.406, p = 0.001) and with percentage weight reduction (r = 0.321, p = 0.017). Both the groups were comparable in improvement in ODI and SR-MWD scores and patient satisfaction. CONCLUSION Patients with obesity achieve significant reduction in weight and BMI following decompression surgery for LCS. It will further prevent other health conditions attributed to obesity. Both the groups were comparable in ODI, SR-MWD and satisfactory outcome following surgery. Hence obesity should not be a deterring factor for surgical consideration for patients with lumbar canal stenosis.
Collapse
Affiliation(s)
| | - Kushagra Pandey
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Ganesh Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Sachin Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
3
|
Chan JL, Whitmore RG. Commentary: Clinical Outcomes and Radiographic Results of Prone Transpsoas Lateral Lumbar Interbody Fusion: A Single-Institution Case Series. Neurosurgery 2024:00006123-990000000-01331. [PMID: 39240083 DOI: 10.1227/neu.0000000000003165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 08/01/2024] [Indexed: 09/07/2024] Open
Affiliation(s)
- Julie L Chan
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Robert G Whitmore
- Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| |
Collapse
|
4
|
Tan H, Yamamoto EA, Smith S, Yoo J, Kark J, Lin C, Orina J, Philipp T, Ross DA, Wright C, Wright J, Ryu WHA. Characterizing utilization patterns and reoperation risk factors of interspinous process devices: analysis of a national claims database. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:283-290. [PMID: 38065695 DOI: 10.1093/pm/pnad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Interspinous process devices (IPDs) were developed as minimally invasive alternatives to open decompression surgery for spinal stenosis. However, given high treatment failure and reoperation rates, there has been minimal adoption by spine surgeons. This study leveraged a national claims database to characterize national IPD usage patterns and postoperative outcomes after IPD implantation. METHOD Using the PearlDiver database, we identified all patients who underwent 1- or 2-level IPD implantation between 2010 and 2018. Univariate and multivariable logistic regression was performed to identify predictors of the number of IPD levels implanted and reoperation up to 3 years after the index surgery. Right-censored Kaplan-Meier curves were plotted for duration of reoperation-free survival and compared with log-rank tests. RESULTS Patients (n = 4865) received 1-level (n = 3246) or 2-level (n = 1619) IPDs. Patients who were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.01-1.03, P < .001), male (aOR 1.31, 95% CI 116-1.50, P < .001), and obese (aOR 1.19, 95% CI 1.05-1.36, P < .01) were significantly more likely to receive a 2-level IPD than to receive a 1-level IPD. The 3-year reoperation rate was 9.3% of patients when mortality was accounted for during the follow-up period. Older age decreased (aOR 0.97, 95% CI 0.97-0.99, P = .0039) likelihood of reoperation, whereas 1-level IPD (aOR 1.37, 95% CI 1.01-1.89, P = .048), Charlson Comorbidity Index (aOR 1.07, 95% CI 1.01-1.14, P = .018), and performing concomitant open decompression increased the likelihood of reoperation (aOR 1.68, 95% CI 1.35-2.09, P = .0014). CONCLUSION Compared with 1-level IPDs, 2-level IPDs were implanted more frequently in older, male, and obese patients. The 3-year reoperation rate was 9.3%. Concomitant open decompression with IPD placement was identified as a significant risk factor for subsequent reoperation and warrants future investigation.
Collapse
Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Erin A Yamamoto
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Spencer Smith
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jung Yoo
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jonathan Kark
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Clifford Lin
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Josiah Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Travis Philipp
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Donald A Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Christina Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - James Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Won Hyung A Ryu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| |
Collapse
|
5
|
Willems SJ, Coppieters MW, Rooker S, Orzali L, Kittelson AJ, Ostelo RW, Kempen DHR, Scholten-Peeters GGM. The impact of being overweight or obese on 12 month clinical recovery in patients following lumbar microdiscectomy for radiculopathy. Spine J 2024; 24:625-633. [PMID: 37935285 DOI: 10.1016/j.spinee.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND CONTEXT The proportion of patients who undergo lumbar microdiscectomy due to lumbar radiculopathy who are also overweight or obese is high. However, whether high body mass index (BMI) affects clinical outcomes is not well-studied. PURPOSE To investigate the difference in the clinical course between normal weight, overweight, and obese patients with radiculopathy who underwent lumbar microdiscectomy followed by physical therapy and to evaluate whether high BMI is associated with poor recovery. STUDY DESIGN/SETTING A prospective cohort study with a 12-month follow-up was conducted in a multidisciplinary clinic. PATIENT SAMPLE We included 583 patients (median [IQR] age: 45 [35-52] years; 41% female) with clinical signs and symptoms of lumbar radiculopathy, consistent with magnetic resonance imaging findings, who underwent microdiscectomy followed by postoperative physical therapy. OUTCOME MEASURES Outcomes were leg pain and back pain intensity measured with a visual analogue scale, disability measured with the Roland Morris Disability Questionnaire at 3 and 12-month follow-ups, and complications. METHODS Patients were classified as being normal weight (46.9%), overweight (38.4%), or obese (14.7%). A linear mixed-effects model was used to assess the difference in the clinical course of pain and disability between the three BMI categories. The association between BMI and outcomes was evaluated using univariable and multivariable logistic regression analyses. RESULTS All three patient groups experienced a significant improvement in leg pain, back pain, and disability over 3 and 12-month follow-up. Patients who were overweight, obese, or normal weight experienced comparable leg pain (p=.14) and disability (p=.06) over the clinical course (p=.14); however, obese patients experienced higher back pain (MD=-6.81 [95%CI: -13.50 to -0.14]; p=.03). The difference in back pain scores was not clinically relevant. CONCLUSIONS In the first year following lumbar microdiscectomy, patients demonstrated clinical improvements and complications that were unrelated to their preoperative BMI.
Collapse
Affiliation(s)
- Stijn J Willems
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - Michel W Coppieters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia; School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia
| | - Servan Rooker
- Department of Neurosurgery, Kliniek ViaSana, Hoogveldeseweg 1, 5451AA Mill, The Netherlands; Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Campus Drie Eiken, R235, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Luca Orzali
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands
| | - Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, University of Montana, 32 Campus Drive, Missoula, MT 59812, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, 12631 East 17th Avenue, RM 1201G, Aurora, CO 90045, USA
| | - Raymond W Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences research institute, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands; Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location VUmc, Amsterdam Movement Sciences, program Musculoskeletal Health, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Diederik H R Kempen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; Department of Orthopaedics, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - Gwendolyne G M Scholten-Peeters
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, program Musculoskeletal Health, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.
| |
Collapse
|
6
|
Marquardt MD, Gibbs D, Grossbach A, Keister A, Munjal V, Moranville R, Mallory N, Toop N, Dhaliwal J, Marquardt H, Xu D, Viljoen S. Impact of obesity on adult spinal deformity (ASD) long-segment spinal fusion radiographic and clinical outcomes. Clin Neurol Neurosurg 2024; 238:108187. [PMID: 38402706 DOI: 10.1016/j.clineuro.2024.108187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 02/27/2024]
Abstract
STUDY DESIGN Retrospective chart review of patients receiving long-segment fusion during a five-year period. OBJECTIVE To determine whether obese patients receive comparable benefits when receiving long-segment fusion compared to non-obese patients and to identify factors that may predict hardware failure and post-surgical complications among obese patients. METHODS Demographic, spinopelvic radiographic, patient-reported outcome measures (PROMs), and complications data was retrospectively collected from 120 patients who underwent long-segment fusion during a five-year period at one tertiary care medical center. Radiographic measurements were pelvic incidence, pelvic tilt (PT), lumbar lordosis, L4-S1 lordosis, thoracic kyphosis, sagittal vertical axis, PI-LL mismatch, and proximal junction cobb angle at upper instrumented vertebrae + 2 (UIV+2). PROMs were Oswestry disability index, numeric rating scale (NRS) Back Pain, NRS Leg Pain, RAND SF-36 pain, and RAND SF-36 physical functioning. Included patients were adults and had at least 2-years of postoperative follow-up. Descriptive and multivariate statistical analysis was performed with α = 0.05. RESULTS Patients with a BMI ≥ 30 (n=63) and patients with a BMI < 30 (n=57) demonstrated comparable improvements (P>0.05) for all spinopelvic radiographic measurements and PROMs. Each cohort demonstrated significant improvements from pre-assessment to post-assessment on nearly all spinopelvic radiographic measurements and PROMs (P<0.05), except PT and L4-S1 lordosis where neither group improved (p=0.95 and 0.58 for PT and P=0.23 and 0.11 for L4-S1 lordosis fornon-obese and obese cohorts respectively) and SF-36 physical functioning where the non-obese cohort not statistically improve (P=0.08). Patients with a BMI ≥ 30 demonstrated an increased incidence of cardiovascular complications (P=0.0293), acute kidney injury (P=0.0241), rod fractures (P=0.0293), and reoperations (P=0.0241) when compared to patients with a BMI < 30. CONCLUSION This study adds to a growing body of evidence linking demographic factors with risks of hardware failure. Further, this data challenges the assumption that obese patients may not receive sufficient benefit to be long-segment surgical candidates. However, given their elevated risk for post-operative and delayed hardware complications, obese patients should be appropriately counseling before undergoing surgery.
Collapse
Affiliation(s)
| | - David Gibbs
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Andrew Grossbach
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Alexander Keister
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Vikas Munjal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Robert Moranville
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Noah Mallory
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Nathaniel Toop
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Joravar Dhaliwal
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Henry Marquardt
- The Ohio State University College of Medicine, Columbus, OH, United States; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - David Xu
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Stephanus Viljoen
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
7
|
Hu Y, Qi J, Dong Y, Zhang H, Zhou Q, Bai J, Wang C, Chen Z, Li W, Tian Y, Sun C. Development and validation of a novel thoracic spinal stenosis surgical invasiveness index: a single-center study based on 989 patients. Spine J 2023; 23:1296-1305. [PMID: 37100245 DOI: 10.1016/j.spinee.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND CONTEXT Surgical invasiveness indices have been established for general spine surgery (surgical invasiveness index [SII]), spine deformity, and metastatic spine tumors; however, a specific index for thoracic spinal stenosis (TSS) has not been developed. PURPOSE To develop and validate a novel invasiveness index, incorporating TSS-specific factors for open posterior TSS surgery, which may facilitate the prediction of operative duration and intraoperative blood loss, and the stratification of surgical risk. STUDY DESIGN A retrospective observational study. PATIENT SAMPLE Overall, 989 patients who underwent open posterior TSS surgeries at our institution during the past 5 years were included. OUTCOME MEASURES The operation duration, estimated blood loss, transfusion status, major surgical complications, length of hospital stay, and medical expenses. METHODS We retrospectively analyzed the data of 989 consecutive patients who underwent posterior surgery for TSS between March 2017 and February 2022. Among them, 70% (n=692) were randomly placed in a training cohort, and the remaining 30% (n=297) automatically constituted the validation cohort. Multivariate linear regression models of operative time and log-transformed estimated blood loss were created using TSS-specific factors. Beta coefficients derived from these models were used to construct a TSS invasiveness index (TII). The ability of the TII to predict surgical invasiveness was compared with that of the SII and assessed in a validation cohort. RESULTS The TII was more strongly correlated with operative time and estimated blood loss (p<.05) and explained more variability in operative time and estimated blood loss than the SII (p<.05). The TII explained 64.2% of operative time and 34.6% of estimated blood loss variation, whereas the SII explained 38.7% and 22.5%, respectively. In further verification, the TII was more strongly associated with transfusion rate, drainage time, and length of hospital stay than SII (p<.05). CONCLUSIONS By incorporating TSS-specific components, the newly developed TII more accurately predicts the invasiveness of open posterior TSS surgery than the previous index.
Collapse
Affiliation(s)
- Yuanyu Hu
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Junbo Qi
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Yanlei Dong
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trails Unit, The First Affiliated Hospital of Sun Yat-sen University, No. 58 Zhong Shan Er Rd, Guangzhou 510080, China
| | - Jvcheng Bai
- Shoulder Surgery Department of the Institute of Sports Medicine, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Chaoxin Wang
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Zhongqiang Chen
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Weishi Li
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China
| | - Chuiguo Sun
- Department of Orthopedics, Peking University Third Hospital, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Engineering Research Center of Bone and Joint Precision Medicine, No. 49 North Garden Rd, Haidian District, Beijing 100191, China; Beijing Key Laboratory of Spinal Disease Research, No. 49 North Garden Rd, Haidian District, Beijing 100191, China.
| |
Collapse
|
8
|
Jakoi AM, Kirchner GJ, Lieber AM, Khalsa AS. Marijuana Use is Not a Contraindication for Tranexamic Acid Utilization in Lumbar Spine Surgery. Global Spine J 2023; 13:1771-1776. [PMID: 35014544 PMCID: PMC10556919 DOI: 10.1177/21925682211049166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to evaluate safety in lumbar spinal fusion with tranexamic acid (TXA) utilization in patients using marijuana. METHODS This was a retrospective cohort study involving a single surgeon's cases of 1 to 4 level lumbar fusion procedures. Two hundred and ninety-four patients were followed for ninety days post-operatively. Consecutive patients were self-reported for daily marijuana use (n = 146) and compared to a similar cohort of patients who denied usage of marijuana (n = 146). Outcomes were collected, which included length of stay (LOS), estimated blood loss (EBL), post-operative myocardial infarction, seizures, deep venous thrombosis, pulmonary embolus, death, readmission, need for further surgery, infection, anaphylaxis, acute renal injury, and need for blood product transfusion. RESULTS Patients in the marijuana usage cohort had similar age (58.9 years ±12.9 vs 58.7 years ±14.8, P = .903) and distribution of levels fused (P = .431) compared to the non-usage cohort. Thromboembolic events were rare in both groups (marijuana usage: 1 vs non-usage: 2). Compared to the non-usage cohort, the marijuana usage cohort had a similar average EBL (329.9 ± 298.5 mL vs 374.5 ± 363.8 mL; P = .254). Multivariate regression modeling demonstrated that neither EBL (OR 1.27, 95% CI 0.64-2.49) nor need for transfusion (OR 1.56, 95% CI 0.43-5.72) varied between cohorts. The non-usage cohort had twice the risk of prolonged LOS compared to the marijuana usage cohort (OR 2.05, 95% CI 1.15-3.63). CONCLUSION Marijuana use should not be considered a contraindication for TXA utilization in lumbar spine surgery.
Collapse
Affiliation(s)
| | - Gregory J. Kirchner
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Alexander M. Lieber
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amrit S. Khalsa
- Department of Orthopaedic Surgery, The University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
9
|
Nakajima K, Miyahara J, Ohtomo N, Nagata K, Kato S, Doi T, Matsubayashi Y, Taniguchi Y, Kawamura N, Higashikawa A, Takeshita Y, Fukushima M, Ono T, Hara N, Azuma S, Iwai H, Oshina M, Sugita S, Hirai S, Masuda K, Tanaka S, Oshima Y. Impact of body mass index on outcomes after lumbar spine surgery. Sci Rep 2023; 13:7862. [PMID: 37188788 DOI: 10.1038/s41598-023-35008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/11/2023] [Indexed: 05/17/2023] Open
Abstract
The impact of body mass index (BMI) on outcomes after lumbar spine surgery is currently unknown. Previous studies have reported conflicting evidence for patients with high BMI, while little research has been conducted on outcomes for underweight patients. This study aims to examine the impact of BMI on outcomes after lumbar spine surgery. This prospective cohort study enrolled 5622 patients; of which, 194, 5027, and 401 were in the low (< 18.5 kg/m2), normal (18.5-30), and high (≥ 30) BMI groups, respectively. Pain was assessed via the numerical pain rating scale (NPRS) for the lower back, buttock, leg, and plantar area. Quality of life was assessed via the EuroQol 5 Dimension (EQ-5D) and Oswestry Disability Index (ODI). Inverse probability weighting with propensity scores was used to adjust patient demographics and clinical characteristics between the groups. After adjustment, the 1-year postoperative scores differed significantly between groups in terms of leg pain. The proportion of patients who achieved a 50% decrease in postoperative NPRS score for leg pain was also significantly different. Obese patients reported less improvement in leg pain after lumbar spine surgery. The outcomes of patients with low BMI were not inferior to those of patients with normal BMI.
Collapse
Affiliation(s)
- Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kanagawa, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Masayoshi Fukushima
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Spine Center, Toranomon Hospital, Tokyo, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Nobuhiro Hara
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Seiichi Azuma
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Hiroki Iwai
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Masahito Oshina
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Spine Center, NTT Medical Center Tokyo, Tokyo, Japan
| | - Shurei Sugita
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Shima Hirai
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Sagamihara National Hospital, Kanagawa, Japan
| | - Kazuhiro Masuda
- University of Tokyo Spine Group (UTSG), Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.
| |
Collapse
|
10
|
Alsoof D, Johnson K, McDonald CL, Daniels AH, Cohen EM. Body Mass Index and Risk of Complications After Posterior Lumbar Spine Fusion: A Matched Cohort Analysis Investigating Underweight and Obese Patients. J Am Acad Orthop Surg 2023; 31:e394-e402. [PMID: 36525561 DOI: 10.5435/jaaos-d-22-00667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/25/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Previous studies have demonstrated that obesity is associated with increased complications after lumbar fusion. However, there are little published data on the effect of being underweight on lumbar fusion outcomes. The purpose of this study was to elucidate the effect of being underweight versus obese on outcomes after lumbar spinal fusion. METHODS Lumbar spinal fusion patients were identified through the PearlDiver Mariner database between 2010 and 2020. Study groups were created using International Classification of Diseases codes to identify preoperative body mass index (BMI) category as morbid obesity (BMI > 40), obesity (BMI 30 to 40), normal BMI (BMI 20 to 30), and underweight (BMI < 20) cohorts. Complications that occurred within 1 year postoperatively in this study and matched control groups were then isolated. Statistical analyses were conducted using the Pearson chi square method. RESULTS A total of 62,616 patients were identified in this analysis. This included 1,258 underweight patients (4.0%), 17,996 obese patients (57.5%), and 12,054 morbidly obese patients (38.5%). The number of patients to experience any postoperative complication was 766 (60.9%), 9,440 (52.4%), and 6,982 (57.9%) for the underweight, obese, and morbidly obese cohorts, respectively. Underweight patients showed an increased likelihood of complications related to instrumentation (odds ratio [OR] 1.85, P = 0.0237), revision fusion (OR 1.34, P = 0.04061), pulmonary complications (OR 1.43, P < 0.001), and sepsis (OR 1.91, P < 0.001). Obese patients with BMI 30 to 40 showed increased odds of the following complications: hemorrhages and hematomas (OR 1.20, P = 0.02634), surgical site complications (OR 1.27, P < 0.001), thromboembolism (OR 1.78, P < 0.001), and urinary complications (OR 1.08, P < 0.001). Morbidly obese patients with BMI > 40 showed increased odds of all complications analyzed in this study. CONCLUSION This investigation indicates that both underweight and obese patients are at elevated risk of complications after lumbar fusion. Similar to obese patients, underweight patients may benefit from preoperative optimization by nutrition counseling to avoid potential complications. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Daniel Alsoof
- From the Department of Orthopaedics, Alpert Medical School of Brown University, Richmond St Providence, RI (Alsoof, McDonald, Daniels, and Cohen) and the Alpert Medical School of Brown University (Johnson), Richmond St Providence, RI
| | | | | | | | | |
Collapse
|
11
|
Arora A, Wague A, Srinivas R, Callahan M, Peterson TA, Theologis AA, Berven S. Risk factors for extended length of stay and non-home discharge in adults treated with multi-level fusion for lumbar degenerative pathology and deformity. Spine Deform 2022; 11:685-697. [PMID: 36520257 PMCID: PMC10147745 DOI: 10.1007/s43390-022-00620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To identify independent risk factors, including the Risk Assessment and Prediction Tool (RAPT) score, associated with extended length of stay (eLOS) and non-home discharge following elective multi-level instrumented spine fusion operations for diagnosis of adult spinal deformity (ASD) and lumbar degenerative pathology. METHODS Adults who underwent multi-level ([Formula: see text] segments) instrumented spine fusions for ASD and lumbar degenerative pathology at a single institution (2016-2021) were reviewed. Presence of a pre-operative RAPT score was used as an inclusion criterion. Excluded were patients who underwent non-elective operations, revisions, operations for trauma, malignancy, and/or infections. Outcomes were eLOS (> 7 days) and discharge location (home vs. non-home). Predictor variables included demographics, comorbidities, operative information, Surgical Invasiveness Index (SII), and RAPT score. Fisher's exact test was used for univariate analysis, and significant variables were implemented in multivariate binary logistic regression, with generation of 95% percent confidence intervals (CI), odds ratios (OR), and p-values. RESULTS Included for analysis were 355 patients. Post-operatively, 36.6% (n = 130) had eLOS and 53.2% (n = 189) had a non-home discharge. Risk factors significant for a non-home discharge were older age (> 70 years), SII > 36, pre-op RAPT < 10, DMII, diagnosis of depression or anxiety, and eLOS. Risk factors significant for an eLOS were SII > 20, RAPT < 6, and an ASA score of 3. CONCLUSION The RAPT score and SII were most important significant predictors of eLOS and non-home discharges following multi-level instrumented fusions for lumbar spinal pathology and deformity. Preoperative optimization of the RAPT's individual components may provide a useful strategy for decreasing LOS and modifying discharge disposition.
Collapse
Affiliation(s)
- Ayush Arora
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA
| | - Aboubacar Wague
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA
| | - Ravi Srinivas
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA
| | - Matt Callahan
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA
| | - Thomas A Peterson
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA.,Bakar Computational Health Sciences Institute, UCSF, San Francisco, CA, USA
| | - Alekos A Theologis
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California - San Francisco (UCSF), San Francisco, 500 Parnassus Ave, MUW320W, San Francisco, CA, USA.
| |
Collapse
|
12
|
Singh K, Cha EDK, Lynch CP, Nolte MT, Parrish JM, Jenkins NW, Jacob KC, Patel MR, Vanjani NN, Pawlowski H, Prabhu MC, Myers JA. Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions. Clin Spine Surg 2022; 35:E601-E609. [PMID: 35344514 DOI: 10.1097/bsd.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE Develop an evidence-based preoperative risk assessment scoring system for patients undergoing anterior lumbar interbody fusion (ALIF). SUMMARY OF BACKGROUND DATA ALIF may hold advantages over other fusion techniques in sagittal restoration and fusion rates, though it introduces unique risks to vascular and abdominal structures and thus possibly increased risk of operative morbidity. METHODS Primary, 1 or 2-level ALIFs were identified in a surgical registry. Baseline characteristics were recorded. Axial magnetic resonance imagings at L4-L5 and L5-S1 were reviewed for vascular confluence/bifurcation or anomalous structures, and measured for operative window size/slope. To assess favorable outcomes, a clinical grade was calculated: (clinical grade=blood loss×operative duration), higher value indicating poorer outcome. To establish a risk scoring system, a base risk score algorithm was established and stratified into 5 categories: high, high to intermediate, intermediate, intermediate to low, and low. Modifiers to base risk score included age, body mass index, operative level, history of bone morphogenic protein use, calcified vasculature, spondylolisthesis grade, working window size and slope, and abnormal vasculature. Modifiers were weighted for contribution to surgical risk. A total risk score was calculated and evaluated for strength of association with clinical outcome grades by Pearson correlation coefficient. RESULTS A total of 65 patients were included. Mean clinical outcome grade was 5.6, mean total risk score 21.3±21.5. Multilevel procedures (L4-S1) mean total risk score was 57.3±7.8. L4-L5 mean total risk score was 23.6±5.2; L5-S1 mean total risk score 8.3±6.6. Correlation analysis demonstrated a significant and strong relationship (| r |=0.753; P <0.001) between total risk scores and clinical outcome grades. CONCLUSION Calculated ALIF risk scores significantly correlated with operative duration and blood loss. This scoring system represents a potential framework to facilitate clinical decision-making and risk assessment for potential ALIF candidates with degenerative spinal pathologies.
Collapse
|
13
|
Cofano F, Perna GD, Bongiovanni D, Roscigno V, Baldassarre BM, Petrone S, Tartara F, Garbossa D, Bozzaro M. Obesity and Spine Surgery: A Qualitative Review About Outcomes and Complications. Is It Time for New Perspectives on Future Researches? Global Spine J 2022; 12:1214-1230. [PMID: 34128419 PMCID: PMC9210241 DOI: 10.1177/21925682211022313] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES An increasing number of obese patients requires operative care for degenerative spinal disorders. The aim of this review is to analyze the available evidence regarding the role of obesity on outcomes after spine surgery. Peri-operative complications and clinical results are evaluated for both cervical and lumbar surgery. Furthermore, the contribution of MIS techniques for lumbar surgery to play a role in reducing risks has been analyzed. METHODS Only articles published in English in the last 10 years were reviewed. Inclusion criteria of the references were based on the scope of this review, according to PRISMA guidelines. Moreover, only paper analyzing obesity-related complications in spine surgery have been selected and thoroughly reviewed. Each article was classified according to its rating of evidence using the Sacket Grading System. RESULTS A total number of 1636 articles were found, but only 130 of them were considered to be relevant after thorough evaluation and according to PRISMA checklist. The majority of the included papers were classified according to the Sacket Grading System as Level 2 (Retrospective Studies). CONCLUSION Evidence suggest that obese patients could benefit from spine surgery and outcomes be satisfactory. A higher rate of peri-operative complications is reported among obese patients, especially in posterior approaches. The use of MIS techniques plays a key role in order to reduce surgical risks. Further studies should evaluate the role of multidisciplinary counseling between spine surgeons, nutritionists and bariatric surgeons, in order to plan proper weight loss before elective spine surgery.
Collapse
Affiliation(s)
- Fabio Cofano
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy,Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Giuseppe Di Perna
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Daria Bongiovanni
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Vittoria Roscigno
- Division of Endocrinology, Andrology and Metabolism, Humanitas Gradenigo Hospital, Turin, Italy
| | - Bianca Maria Baldassarre
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Salvatore Petrone
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy,Salvatore Petrone, Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Via Cherasco 15, Turin 10126, Italy.
| | - Fulvio Tartara
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience “Rita Levi Montalcini,” Unit of Neurosurgery, University of Turin, Turin, Italy
| | - Marco Bozzaro
- Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
| |
Collapse
|
14
|
|
15
|
Chen X, Lin GX, Rui G, Chen CM, Kotheeranurak V, Wu HJ, Zhang HL. Comparison of Perioperative and Postoperative Outcomes of Minimally Invasive and Open TLIF in Obese Patients: A Systematic Review and Meta‑Analysis. J Pain Res 2022; 15:41-52. [PMID: 35023969 PMCID: PMC8747800 DOI: 10.2147/jpr.s329162] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 12/21/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Previous studies have demonstrated that minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) is comparable to the open approach in terms of efficacy and safety. However, few comparative studies of surgical procedures in patients with obesity show that they may react differently to open-TLIF (O-TLIF) and MI-LTIF approaches. PATIENTS AND METHODS The main indicators were complications, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) score, and secondary indicators were operative time, blood loss, and hospital stay. RESULTS No significant differences in the VAS and ODI scores for back pain at the last follow-up and wound infection rates were observed between the two groups. Dural tear incidence and complication rate were significantly lower in the MI-TLIF group than that in the O-TLIF group (P = 0.002 and 0.001, respectively). No significant difference in operative time was found between the two groups. There was less blood loss and shorter hospital stay (P = 0.001 and 0.002, respectively) in the MI-TLIF group than that in the O-TLIF group. CONCLUSION Compared with O-TLIF, MI-TLIF is an effective and safe surgical option for patients with obesity, which resulted in similar improvements in pain and functional disability, as well as a lower complication rate.
Collapse
Affiliation(s)
- Xin Chen
- Department of Fifth Surgical, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, People's Republic of China
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Vit Kotheeranurak
- Spine Unit, Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Hua-Jian Wu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Huang-Lin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| |
Collapse
|
16
|
Tabatabai S, Do Q, Min J, Tang CJ, Pleasants D, Sands LP, Du P, Leung JM. Obesity and perioperative outcomes in older surgical patients undergoing elective spine and major arthroplasty surgery. J Clin Anesth 2021; 75:110475. [PMID: 34352602 PMCID: PMC11046412 DOI: 10.1016/j.jclinane.2021.110475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To determine whether obesity status is associated with perioperative complications, discharge outcomes and hospital length of stay in older surgical patients. DESIGN Secondary analysis of five independent study cohorts (N = 1262). SETTING An academic medical center between 2001 and 2017 in the United States. PATIENTS Patients aged 65 years or older who were scheduled to undergo elective spine, knee, or hip surgery with an expected hospital stay of at least 2 days. MEASUREMENTS Body mass index (BMI) was stratified as nonobese (BMI ≤ 30 kg/m2), obesity class 1 (30 kg/m2 ≤ BMI < 35 kg/m2) or obesity class 2-3 (BMI ≥ 35 kg/m2). Primary outcomes included predefined intraoperative and postoperative complications, hospital length of stay (LOS), and discharge location. Univariate and multivariate logistic regression was performed. MAIN RESULTS Obesity status was not associated with intraoperative adverse events. However, obesity class 2-3 significantly increased the risk for postoperative complications (IRR 1.43, 95% CI 1.03-1.95, P = 0.03), hospital LOS (IRR 1.13, 95% CI 1.02-1.25, P = 0.02) and non-home discharge destination (OR 1.95, 95% CI 1.35-2.81, P < 0.001) after accounting for patient related factors and surgery type. CONCLUSIONS Obesity class 2-3 status has prognostic value in predicting an increased incidence of postoperative complications, increased hospital LOS, and non-home discharge location. These results have important clinical implications for preoperative informed consent and provide areas to target for care improvement for the older obese individual.
Collapse
Affiliation(s)
- Sanam Tabatabai
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Quyen Do
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Jie Min
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Christopher J Tang
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Devon Pleasants
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America
| | - Laura P Sands
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Pang Du
- Virginia Tech, Center for Gerontology and Department of Statistics, Blacksburg, VA, United States of America
| | - Jacqueline M Leung
- University of California, Department of Anesthesia & Perioperative Care, San Francisco, CA, United States of America.
| |
Collapse
|
17
|
Ankrah NK, Eli IM, Magge SN, Whitmore RG, Yew AY. Age, body mass index, and osteoporosis are more predictive than imaging for adjacent-segment reoperation after lumbar fusion. Surg Neurol Int 2021; 12:453. [PMID: 34621568 PMCID: PMC8492407 DOI: 10.25259/sni_667_2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/05/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Adjacent-segment disease (ASD) is a well-described long-term complication after lumbar fusion. There is a lack of consensus about the risk factors for development of ASD, but identifying them could improve surgical outcomes. Our goal was to analyze the effect of patient characteristics and radiographic parameters on the development of symptomatic ASD requiring revision surgery after posterior lumbar fusion. Methods: In this retrospective cohort study, we identified patients who underwent lumbar fusion surgery and revision surgery from May 2012 to November 2018 using an institutional lumbar fusion registry. Patients having both pre- and post-operative upright radiographs were included in the study. Revision surgeries for which the index operation was performed at an outside hospital were excluded from analysis. Univariate analysis was conducted on candidate variables, and variables with P< 0.2 were selected for multivariate logistic regression. Results: Of the 106 patients identified, 21 required reoperation (29 months average follow-up). Age >65 years (OR 4.14, 95% CI 1.46–11.76, P= 0.008), body mass index (BMI) >34 (OR 1.13, 95% CI 1.04–1.23, P = 0.004), and osteoporosis (OR 14, 95% CI 1.38–142.42, P = 0.03) were independent predictors of reoperation in the multivariate analysis. Increased facet diastasis at fusion levels (OR 0.60, 95% CI 0.42–0.85, P = 0.004) was associated with reduced reoperation rates. Change in segmental LL at the index operation level, rostral and caudal facet diastasis, vacuum discs, and T2 hyperintensity in the facets were not predictors of reoperation. Conclusion: Age >65, BMI >34, and osteoporosis were independent predictors of adjacent-segment reoperation after lumbar spinal fusion.
Collapse
Affiliation(s)
- Nii-Kwanchie Ankrah
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Ilyas M Eli
- Department of Neurosurgery, University of Utah, Clinical Neurosciences Center, Salt Lake City, Utah, United States
| | - Subu N Magge
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Robert G Whitmore
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| | - Andrew Y Yew
- Department of Neurosurgery, Lahey Clinic, Burlington, Massachusetts, United States
| |
Collapse
|
18
|
Abstract
BACKGROUND To investigate the risk factors for postoperative venous thromboembolism (VTE) in patients undergoing spinal surgery. METHODS Literature published in PubMed, Embase, the Cochrane Library, and Web of Science was systematically reviewed to assess risk factors for VTE following spinal surgery. The data analysis was conducted with STATA 12.0. Data were pooled using fixed-effects or random-effects models according to the heterogeneity among the included studies. RESULTS Twenty-six studies involving 3,216,187 patients were included in this meta-analysis, and the total incidence of VTE after spinal surgery was 0.35% (0.15-29.38%). The pooled analysis suggested that the incidence of VTE after spinal surgery was higher in such aspects as increasing age (weighted mean difference [WMD] 0.55 years, 95% confidence interval [CI] 0.33-0.78, P < .001), female sex (odds ratio [OR] 1.12, 95% CI 1.01-1.25; P = .034), diabetes (OR 1.34, 95% CI 1.29-1.44; P < .001), chronic kidney disease (OR = 8.31, 95% CI 1.98-34.93; P = .004), nonambulatory preoperative activity status (OR 3.67, 95% CI 2.75-4.83; P < .001), D-dimer level (WMD 1.023, 95% CI 0.162-1.884; P = .02), long duration of operation (WMD 0.73, 95% CI 0.21-1.24; P = .006), spine fusion (OR 1.54, 95% CI 1.31-1.82; P < .001), and blood transfusion (OR 2.31, 95% CI 1.73-3.07; P < .001), and the differences were statistically significant. However, there were no significant differences in body mass index, obesity, hypertension, coronary heart disease, spondylolisthesis, intraoperative blood loss, surgical procedures (anterior lumbar interbody fusion vs posterior intervertebral fusion /translaminar lumbar interbody fusion), or surgical site (lumbar vs thoracic) (all P > .05). CONCLUSION Based on our meta-analysis, we identified several important factors that increased the risk of VTE after spinal surgery. We hope our study provides assistance to spine surgeons so that they can adequately analyze and assess risk factors in patients and then develop preventive measures to reduce the incidence of VTE.
Collapse
Affiliation(s)
- Lu Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
| | - Hongxin Cao
- Department of Medical Oncology, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yunzhen Chen
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
| | - Guangjun Jiao
- Department of Orthopedics, Qilu Hospital of Shandong University and Spine and Spinal Cord Disease Research Center, Shandong University
| |
Collapse
|
19
|
Ottesen TD, Malpani R, Galivanche AR, Zogg CK, Varthi AG, Grauer JN. Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery. Spine J 2020; 20:1085-1095. [PMID: 32194246 PMCID: PMC7380546 DOI: 10.1016/j.spinee.2020.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Past studies have focused on the association of high body mass index (BMI) on spine surgery outcomes. These investigations have reported mixed conclusions, possible due to insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (e.g. underweight, overweight, and obese). Few studies have considered outcomes of patients with low BMI. PURPOSE To analyze how anterior cervical spine surgery outcomes track with World Health Organization categories of BMI to better assess where along the BMI spectrum patients are at risk for adverse perioperative outcomes. DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients undergoing elective anterior cervical spine surgery were abstracted from the 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program database. OUTCOME MEASURES Thirty-day adverse events, hospital readmissions, postoperative infections, and mortality. METHODS Patients undergoing anterior cervical spine procedures (anterior cervical discectomy and fusion, anterior cervical corpectomy, cervical arthroplasty) were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Patients were then aggregated into modified World Health Organization categories of BMI. Odds ratios of adverse outcomes, normalized to average risk of normal weight subjects (BMI 18.5-24.9 kg/m2), were calculated. Multivariate analyses were then performed on aggregated adverse outcome categories controlling for demographics (age, sex, functional status) and overall health as measured by the American Society of Anesthesiologists classification. RESULTS In total, 51,149 anterior cervical surgery patients met inclusion criteria. Multivariate analyses revealed the odds of any adverse event to be significantly elevated for underweight and super morbidly obese patients (Odds Ratios [OR] of 1.62 and 1.55, respectively). Additionally, underweight patients had elevated odds of serious adverse events (OR=1.74) and postoperative infections (OR=1.75) and super morbidly obese patients had elevated odds of minor adverse events (OR=1.72). Relative to normal BMI patients, there was no significant elevation for any adverse outcomes for any of the other overweight/obese categories, in fact some had reduced odds of various adverse outcomes. CONCLUSIONS Underweight and super morbidly obese patients have the greatest odds of adverse outcomes after anterior cervical spine surgery. The current study identifies underweight patients as an at-risk population that has previously not received significant focus. Physicians and healthcare systems should give additional consideration to this population, as they often already do for those at the other end of the BMI spectrum.
Collapse
Affiliation(s)
- Taylor D Ottesen
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Cheryl K Zogg
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Arya G Varthi
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA.
| |
Collapse
|
20
|
Han L, Han H, Wang L, Ruan Y, Wei X, He J, Lu X. Prior bariatric surgery is associated with lower complications, in-hospital mortality, and healthcare utilization after elective spine fusion surgery. Surg Obes Relat Dis 2020; 16:760-767. [PMID: 32278540 DOI: 10.1016/j.soard.2019.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Grade 3 obesity could potentially increase postoperative complications after spinal fusion surgery. However, the relationship between prior bariatric surgery (BS) and postoperative complications after spinal fusion surgery is not well-established. SETTING Inpatient hospital admissions from the Nationwide Inpatient Sample. METHODS Patients with a primary procedure of spinal fusion surgery discharged between 2006 and 2014 were identified. In-hospital outcomes included postoperative complications, mortality, cost, and length of stay were compared between patients with prior BS and grade 3 obesity. RESULTS A total of 3,132,192 patients who underwent elective spinal fusion surgery were identified. There were 33,936 (1.1%) patients with a diagnosis of prior BS. The prevalence of prior BS increased significantly from .1% in 2006 to 1.5% in 2014. Compared with patients with grade 3 obesity, patients with prior BS were younger, more likely to be female, had less co-morbidities, and higher proportion of cervical surgery. Multivariable analysis indicated that patients with prior BS had lower risk of overall complications (odds ratio [OR]: .44; 95% confidence interval [CI]: .38-.49), neurologic (OR: .55; 95%CI: .35-.84), respiratory (OR: .30; 95%CI: .23-.37), cardiac (OR: .38; 95%CI: .24-.60), gastrointestinal (OR: .61; 95%CI: .44-.84), urinary and renal (OR: .34; 95%CI: .26-.44), venous thromboembolism (OR: .35; 95%CI: .19-.63), wound-related complications (OR: .67; 95%CI: .53-.85), and in-hospital mortality (OR: .12; 95%CI: .02-.88). Prior BS was also related to 13% shorter length of stay and 2% lower cost. CONCLUSIONS Among patients undergoing spinal fusion surgery, prior BS is associated with lower complications, in-hospital mortality, and healthcare utilization. BS might mitigate risk of worse outcomes associated with grade 3 obesity after spine fusion surgery.
Collapse
Affiliation(s)
- Lin Han
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hedong Han
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Liang Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yiming Ruan
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xin Wei
- Department of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China; Tongji University School of Medicine, Shanghai, China.
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
| |
Collapse
|
21
|
Complexities of spine surgery in obese patient populations: a narrative review. Spine J 2020; 20:501-511. [PMID: 31877389 PMCID: PMC7136130 DOI: 10.1016/j.spinee.2019.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 02/03/2023]
Abstract
The obese population is particularly challenging to the spine surgeon in all phases of care. A narrative literature review was performed to review difficulties in spine surgery on the obese patient population and techniques for mitigation. We specifically aimed to assess several topics with regard to this population: patient selection and preoperative care; intraoperative and surgical techniques; and postoperative care, outcomes, and complications. The literature review demonstrated that obese patients are at increased surgical risk with spine surgery due to a variety of factors at all stages of intervention. Preoperatively, obese patients have worse outcomes with physical therapy and present technical difficulties for injections. Transport to a hospital, imaging, resuscitation, and intubation are all challenged by increased body habitus. Intraoperatively, obese patients have increased operative times, blood loss, surgical site infections, and nerve palsies. Patient positioning and intraoperative imaging may be limited. Surgery itself may be technically challenging due to body habitus and minimally invasive techniques are becoming more prevalent in this population. Postoperatively, several studies demonstrate that obese patients have inferior outcomes compared with nonobese counterparts. Patient selection is a key for elective interventions, and appropriate infrastructure aids in the ultimate outcomes for both elective and nonelective surgical treatments. Overall, obese patients present several challenges to the spine surgeon, and certain precautions can be undertaken preoperatively, intraoperatively, and postoperatively to mitigate the associated risks to optimize outcomes.
Collapse
|
22
|
Janka M, Schuh A, Schwemmer U, Merkel A. [The obese patient in spine surgery]. MMW Fortschr Med 2019; 161:62-64. [PMID: 31828628 DOI: 10.1007/s15006-019-1239-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Janka
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt, Deutschland.
| | - Alexander Schuh
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt, Deutschland
| | - Ulrich Schwemmer
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt, Deutschland
| | - Andreas Merkel
- Muskuloskelettales Zentrum, Kliniken des Landkreises Neumarkt i. d. OPf., Nürnberger Str. 12, D-92318, Neumarkt, Deutschland
| |
Collapse
|
23
|
Impact of obesity on restoration of sagittal balance and clinical efficacy after posterior lumbar interbody fusion. J Clin Neurosci 2019; 69:170-174. [DOI: 10.1016/j.jocn.2019.07.074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/11/2019] [Accepted: 07/29/2019] [Indexed: 01/30/2023]
|
24
|
Beck EC, Nwachukwu BU, Chahla J, Jan K, Keating TC, Suppauksorn S, Nho SJ. Patients With Borderline Hip Dysplasia Achieve Clinically Significant Outcome After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With Minimum 2-Year Follow-up. Am J Sports Med 2019; 47:2636-2645. [PMID: 31419157 DOI: 10.1177/0363546519865919] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a growing trend for hip arthroscopists to treat patients with borderline hip dysplasia (BHD) for femoroacetabular impingement syndrome (FAIS) without addressing the acetabular coverage. However, the literature of outcomes and failure rates for these patients is conflicting. PURPOSE (1) To identify whether patients with BHD achieved 2-year similar patient-reported outcome, minimal clinically important difference (MCID), and patient acceptable symptomatic state (PASS) when compared with patients without BHD and (2) to identify predictors for achieving the MCID and PASS among patients with BHD who are undergoing hip arthroscopy for FAIS. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Data from consecutive patients who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS between January 2012 and January 2017 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA], 20°-25°) were matched 2:1 by age, sex, and body mass index (BMI) to control patients with normal acetabular coverage (LCEA, >25°-40°). Patient-reported outcome, MCID, and PASS were compared between the groups. Multivariate logistic regression analysis identified significant predictors of achieving the MCID and PASS in the BHD group. RESULTS The MCID in the BHD group was defined as 9.2, 13.7, 8.5, and 15.2 for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific, modified Harris Hip Score, and iHOT-12, respectively. Threshold scores for achieving the PASS in both groups were 87.9, 76.4, 78.1, and 60.0. A total of 112 patients were identified as having BHD (LCEA, 20°-25°) and were matched to 224 controls. Both groups saw statistically significant increases in score averages over the 2-year period; however, the differences between them were not statistically significant (P > .05 for all). There was no statistical difference in the frequency of the BHD and non-BHD cohorts achieving the MCID on at least 1 threshold score (86.6% vs 85.6%, P = .837) and the PASS (78.6% vs 79.8%, P = .79). There was, however, a statistically significant difference between the rates of patients with and without BHD achieving the PASS on the modified Harris Hip Score threshold (62.5% vs 74.5%, P = .028). The final logistic models demonstrated that lower BMI (odds ratio [OR], 0.872; P = .029), lower preoperative alpha angle (OR, 0.965; P = .014), and female sex (OR, 3.647; P = .03) are independent preoperative predictors of achieving the MCID, while lower preoperative alpha angle (OR, 0.943; P = .018) and self-reported limp (OR, 18.53; P = .007) are independent preoperative predictors of achieving the PASS. CONCLUSION Outcome improvements in patients with BHD who are undergoing arthroscopic treatment with capsular closure for FAIS are not significantly different from patients with normal acetabular coverage. Lower BMI, lower alpha angle, absence of limp, and female sex are preoperative predictors of achieving meaningful clinically significant outcome improvements in patients with BHD.
Collapse
Affiliation(s)
- Edward C Beck
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Benedict U Nwachukwu
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kyleen Jan
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy C Keating
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Sunikom Suppauksorn
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Shane J Nho
- Division of Sports Medicine Surgery, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
25
|
Villavicencio A, Lee Nelson E, Rajpal S, Vivek N, Burneikiene S. The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion. Clin Neurol Neurosurg 2019; 179:19-22. [DOI: 10.1016/j.clineuro.2019.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/11/2019] [Accepted: 02/10/2019] [Indexed: 01/24/2023]
|
26
|
Impact of obesity on outcomes following lumbar spine surgery: A systematic review and meta-analysis. Clin Neurol Neurosurg 2018; 177:27-36. [PMID: 30583093 DOI: 10.1016/j.clineuro.2018.12.012] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 11/22/2022]
Abstract
The influence of obesity on spine surgery outcomes is highly controversial with a current clinical equipoise. Several studies suggest higher perioperative morbidity with obesity while other studies suggest otherwise. To address this gap in the literature, we conducted a systematic review and meta-analysis in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with the objective of better defining the impact of obesity on outcomes following lumbar spine surgery. Risk of bias assessment was performed using the Newcastle-Ottawa Scale. Strength of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system. Surgical outcomes such as blood loss, operative time, length of stay, complication and reoperation rates and functional outcomes represented by the change in Oswestry Disability Index and Visual Analog Scale-Back Pain were compared between obese and non-obese patients. A total of 32 studies with 23,415 patients were analyzed. Obese patients had slightly higher surgical blood loss (Mean Difference [MD]: 46.15 ml, CI: 20.21-72, p-value< .001, I2 = 85%) and longer operative times (MD: 17.17 min, CI: 9.91-24.43, p-value< .001, I2 = 95%), but similar length of stay as compared to non-obese patients. Higher complication (OR = 1.34, C.I. = 1.13-1.58, p = 0.01, I2 = 45%) and reoperation rates (OR = 1.40, C.I. = 1.19-1.64, p < 0.001, I2 = 20) were observed in obese patients. The differences, however, were not significant for obese patients undergoing MIS surgery. Functional outcomes (change in ODI and VAS-BP) were similar between the two groups. Overall confidence in GRADE estimates was either low or very low for all outcomes. Obesity might be linked to higher adverse events following lumbar spine surgery. Minimally invasive spine surgery, however, might offer comparable outcomes between obese and non-obese patients. However, further studies are needed to evaluate whether these findings remain valid for morbidly obese (BMI > 40) patients as well.
Collapse
|
27
|
Shaw K, Chen J, Sheppard W, Alazzeh M, Park H, Park DY, Shamie AN. Use of the subcutaneous lumbar spine (SLS) index as a predictor for surgical complications in lumbar spine surgery. Spine J 2018; 18:2181-2186. [PMID: 29709549 DOI: 10.1016/j.spinee.2018.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND CONTEXT Lumbar spine surgeries require adequate exposure to visualize key structures and limited exposure can make surgery more technically difficult, thus increasing the potential for complications. Body mass index and body mass distribution have been shown to be associated with worse surgical outcomes. PURPOSE This study aims to further previous investigations in elucidating the predictive nature of body mass distribution with peri- and postoperative complications in lumbar surgery. STUDY DESIGN/SETTING This is a retrospective study conducted at a single institution. PATIENT SAMPLE Two hundred eighty-five patients who underwent lumbar laminectomy, laminotomy, or posterior lumbar interbody fusion or transforaminal lumbar interbody fusion procedures between 2013 and 2016. OUTCOME MEASURES Magnetic resonance imaging (MRI) results and electronic medical records were reviewed for measurements and relevant complications. METHODS Previously known risk factors were identified and MRI measurements of subcutaneous adipose depth (SAD) relative to spinous process height (SPH) were measured at the surgical site to generate the subcutaneous lumbar spine (SLS) index. This measurement was then analyzed in association with recorded surgical complications. RESULTS The SLS index was found to be a significant risk factor for total complications (0.292, p=.041), perioperative complications (0.202, p=.015), and need for revision surgery (0.285, p<.001). The SAD alone proved to be negatively associated with perioperative complications (-0.075, p=.034) and need for revision surgery (-0.104, p=.001), with no predictive association seen for total or postoperative complications. Linear regression revealed an SLS index of 3.43 as a threshold value associated with a higher risk of total complications, 5.8 for perioperative complications, and 3.81 for the need for revision surgeries. CONCLUSION Body mass distribution of the surgical site as indicated by SAD to SPH (SLS index) is significantly associated with increasing risk of postoperative and perioperative complications as well as increased likelihood for necessary revision surgery. This relationship was shown to be a more accurate indication of perioperative risk than previous standards of body mass index and SAD alone, and may allow spine surgeons to assess surgical risk when considering lumbar spine surgery using simple calculations from standard preoperative MRI results.
Collapse
Affiliation(s)
- Kylie Shaw
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - James Chen
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - William Sheppard
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Mohanad Alazzeh
- David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - Howard Park
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - D Y Park
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - A Nick Shamie
- Department of Orthopaedic Surgery, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA.
| |
Collapse
|
28
|
Prior bariatric surgery lowers complication rates following spine surgery in obese patients. Acta Neurochir (Wien) 2018; 160:2459-2465. [PMID: 30406870 DOI: 10.1007/s00701-018-3722-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is an increasingly common treatment for morbid obesity that has the potential to effect bone and mineral metabolism. The effect of prior BS on spine surgery outcomes has not been well established. The aim of this study was to assess differences in complication rates following spinal surgery for patients with and without a history of BS. METHODS Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years 2004-2013. BS patients and morbidly obese patients (non-BS) were divided into cervical and thoracolumbar surgical groups and propensity score matched for age, gender, and invasiveness and complications compared. RESULTS One thousand nine hundred thirty-nine spine surgery patients with a history of BS were compared to 1625 non-BS spine surgery patients. The average time from bariatric surgery to spine surgery is 2.95 years. After propensity score matching, 740 BS patients were compared to 740 non-BS patients undergoing thoracolumbar surgery, with similar comorbidity rates. The overall complication rate for BS thoracolumbar patients was lower than non-BS (45.8% vs 58.1%, P < 0.001), with lower rates of device-related (6.1% vs 23.2%, P < 0.001), DVT (1.2% vs 2.7%, P = 0.039), and hematomas (1.5% vs 4.5%, P < 0.001). Neurologic complications were similar between BS patients and non-BS patients (2.3% vs 2.7%, P = 0.62). For patients undergoing cervical spine surgery, BS patients experienced lower rates of bowel issues, device-related, and overall complication than non-BS patients (P < 0.05). CONCLUSIONS Bariatric surgery patients undergoing spine surgery experience lower overall complication rates than morbidly obese patients. This study warrants further investigation into these populations to mitigate risks associated with spine surgery for bariatric patients.
Collapse
|