Marquez-Lara Alejandro, Nandyala Sreeharsha V, Sankaranarayanan Sriram, Noureldin Mohamed, Singh Kern
From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Spine (Phila Pa 1976). 2014 May 1;39(10):798-804. doi: 10.1097/BRS.0000000000000232.
Retrospective analysis.
A national population-based database was analyzed to characterize the risks of postoperative complications and mortality associated with the patient's body mass index (BMI) after lumbar spinal surgery.
Obesity has been associated with greater perioperative complications and worsened surgical outcomes after lumbar spinal surgery. However, the stratified BMI risks of postoperative complications relative to normal weight patients have not been well characterized.
The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent lumbar spinal surgery between 2006 and 2011. Patients were stratified into BMI cohorts: normal (18.5-24.99 kg/m), overweight (25.00-29.99 kg/m), class 1 (30.00-34.99 kg/m), class 2 (35.00-39.99 kg/m), and class 3 (≥40 kg/m) obesity. Preoperative patient characteristics and perioperative outcomes were assessed. The relative risks of 30-day postoperative complications and mortality for each BMI cohort were calculated in reference to the normal weight cohort using a 95% confidence interval.
A total of 24,196 patients underwent lumbar spine surgery between 2006 and 2011 of which 19,195 (79.3%) were overweight or obese. The risk for deep vein thrombosis increased beginning with overweight patients and compounded for the subsequent obesity classes. The risk for superficial wound infection and pulmonary embolism increased beginning with the class 1 obesity cohort. Furthermore, the relative risk increase for urinary tract infection, acute renal failure, and sepsis was significantly increased only among class 3 obesity patients. Lastly, there was no relative risk increase in 30-day mortality in any cohort after lumbar spine surgery.
Overweight and obese patients demonstrated an increased risk of postoperative complications relative to normal weight patients. Despite these findings, a BMI 25 kg/m or more was not associated with a greater risk of mortality. Further studies are warranted to characterize the impact of postoperative complications associated with overweight and obese patients on hospital resource utilization and costs after lumbar spine surgery.
回顾性分析。
分析一个基于全国人口的数据库，以描述腰椎手术后患者体重指数（BMI）与术后并发症及死亡率的风险特征。
肥胖与腰椎手术后更高的围手术期并发症及更差的手术结果相关。然而，相对于正常体重患者，术后并发症的分层BMI风险尚未得到很好的描述。
查询美国外科医师学会国家外科质量改进计划数据库，以识别2006年至2011年间接受腰椎手术的患者。患者被分为BMI队列：正常（18.5 - 24.99kg/m²）、超重（25.00 - 29.99kg/m²）、1级肥胖（30.00 - 34.99kg/m²）、2级肥胖（35.00 - 39.99kg/m²）和3级肥胖（≥40kg/m²）。评估术前患者特征和围手术期结果。使用95%置信区间，参照正常体重队列计算每个BMI队列术后30天并发症和死亡率的相对风险。
2006年至2011年间共有24196例患者接受了腰椎手术，其中19195例（79.3%）超重或肥胖。从超重患者开始，深静脉血栓形成风险增加，并在随后的肥胖等级中加剧。浅表伤口感染和肺栓塞风险从1级肥胖队列开始增加。此外，仅在3级肥胖患者中，尿路感染、急性肾衰竭和败血症的相对风险增加显著。最后，腰椎手术后任何队列的30天死亡率均无相对风险增加。
超重和肥胖患者相对于正常体重患者术后并发症风险增加。尽管有这些发现，但BMI 25kg/m²或更高与更高的死亡风险无关。有必要进一步研究以描述超重和肥胖患者术后并发症对腰椎手术后医院资源利用和成本的影响。
