Phan Kevin, Kothari Parth, Lee Nathan J, Virk Sohaib, Kim Jun S, Cho Samuel K
NeuroSpine Surgery Research Group (NSURG), University of New South Wales (UNSW), Sydney, Australia.
Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.
Spine (Phila Pa 1976). 2017 Feb 15;42(4):261-266. doi: 10.1097/BRS.0000000000001711.
Retrospective study of prospectively collected data.
To determine the effect of obesity (body mass Index > 30) on postoperative morbidity and mortality after elective posterior cervical fusion in adults.
In those with spine disease, obesity has been shown to portend poorer general and disease-specific functional health status. The effect of obesity on outcomes after spine surgery, especially posterior cervical fusion, however, remains unclear. Previous studies have been contradictory to one another and largely limited by small sample sizes.
The American College of Surgeons National Surgical Quality Improvement Program is a large multicenter clinical registry that prospectively collects preoperative risk factors, intraoperative variables, and 30-day postoperative morbidity and mortality outcomes from about 400 hospitals nationwide. Current Procedural Terminology codes were used to query the database for adults who underwent posterior cervical fusion between 2005 and 2012. Patients were separated into cohorts based on obesity status. Univariate analysis and multivariate logistic regression were used to analyze the effect of obesity on postoperative morbidity and mortality.
There was a significantly higher rate of only venous thromboembolism (VTE) in the obese group compared with nonobese cohort (3.5% vs. 0.6%, P = 0.015). On multivariate analysis, obesity was found to be an independent predictor (odds ratio 6.15; 95% confidence interval [CI], 1.26-30.20; P = 0.02) for VTE.
The present study demonstrated that patients with obesity can safely undergo posterior cervical fusion surgery. Although obesity predisposed to an elevated risk of VTE, postoperative mortality and morbidity were otherwise not significantly increased in this population.
对前瞻性收集的数据进行回顾性研究。
确定肥胖（体重指数>30）对成人择期颈椎后路融合术后发病和死亡的影响。
在患有脊柱疾病的人群中，肥胖已被证明预示着更差的总体和疾病特异性功能健康状况。然而，肥胖对脊柱手术后结局的影响，尤其是颈椎后路融合术后的影响仍不清楚。以往的研究相互矛盾，且大多受样本量小的限制。
美国外科医师学会国家外科质量改进计划是一个大型多中心临床登记系统，前瞻性收集全国约400家医院的术前危险因素、术中变量以及术后30天的发病和死亡结局。使用当前手术操作术语代码在数据库中查询2005年至2012年间接受颈椎后路融合术的成年人。根据肥胖状况将患者分为不同队列。采用单因素分析和多因素逻辑回归分析肥胖对术后发病和死亡的影响。
与非肥胖队列相比，肥胖组仅静脉血栓栓塞（VTE）发生率显著更高（3.5%对0.6%，P = 0.015）。多因素分析发现，肥胖是VTE的独立预测因素（比值比6.15；95%置信区间[CI]，1.26 - 30.20；P = 0.02）。
本研究表明肥胖患者可以安全地接受颈椎后路融合手术。虽然肥胖易导致VTE风险升高，但该人群的术后死亡率和发病率并未显著增加。
3级。
