Journal
CLINICAL NEUROLOGY AND NEUROSURGERY
Volume 226, Issue -, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.clineuro.2023.107619
Keywords
Obesity; Body mass index; BMI; Outcomes; Adult degenerative scoliosis; ADS; Spine surgery
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This study compared perioperative outcomes of obese versus non-obese adult patients who underwent degenerative scoliosis spine surgery. The results showed that obese patients had more preoperative risk factors, longer operation time, greater blood loss, higher complications, delayed walking postoperatively, and lower discharge rates. Therefore, systematic measures should be taken to improve perioperative outcomes.
Objective: To compare perioperative outcomes of obese versus non-obese adult patients who underwent degen-erative scoliosis spine surgery.Methods: 235 patients who underwent thoracolumbar adult spinal deformity (ASD) surgery (>= 4 levels) were identified and categorized into two cohorts based on their body mass indices (BMI): obese (BMI >= 30 kg/m2; n = 81) and non-obese (BMI <30 kg/m2; n = 154). Preoperative (demographics, co-morbidities, American Society of Anesthesiologists (ASA) score and modified frailty indices (mFI-5 and mFI-11)), intraoperative (estimated blood loss (EBL) and anesthesia duration), and postoperative (complication rates, Oswestry Disability Index (ODI) scores, discharge destination, readmission rates, and survival) characteristics were analyzed by student's t, chi -squared, and Mann-Whitney U tests.Results: Obese patients were more likely to be Black/African-American (p < 0.05, OR:4.11, 95% CI:1.20-14.10), diabetic (p < 0.05, OR:10.18, 95% CI:4.38-23.68) and had higher ASA (p < .01) and psoas muscle indices (p < 0.0001). Furthermore, they had greater pre-and post-operative ODI scores (p < 0.05) with elevated mFI-5 (p < 0.0001) and mFI-11 (p < 0.01). Intraoperatively, obese patients were under anesthesia for longer time periods (p < 0.05) with higher EBL (p < 0.05). Postoperatively, while they were more likely to have complications (OR:1.77, 95% CI:1.01 - 3.08), had increased postop days to initiate walking (p < .05) and were less likely to be discharged home (OR:0.55, 95% CI:0.31-0.99), no differences were found in change in ODI scores or readmission rates between the two cohorts.Conclusions: Obesity increases pre-operative risk factors including ASA, frailty and co-morbidities leading to longer operations, increased EBL, higher complications and decreased discharge to home. Pre-operative assessment and systematic measures should be taken to improve peri-operative outcomes.
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