Flippin Michael, Harris Jessica, Paxton Elizabeth W, Prentice Heather A, Fithian Donald C, Ward Samuel R, Gombatto Sara P
Southern California Permanente Medical Group, Kaiser Permanente, San Diego, CA, USA.
Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA.
J Spine Surg. 2017 Sep;3(3):349-357. doi: 10.21037/jss.2017.06.15.
Conflicting findings exist on the effect of obesity on outcomes of lumbar spine surgery; results depend on the diagnosis studied, procedure evaluated, definition of obesity, and specific outcomes measured. The purpose of this retrospective cohort study is to examine the effect of increasing body mass index (BMI) on surgical-related, health-related, and long-term outcomes of lumbar spine surgery in a single representative patient sample.
Using a surgical registry from an integrated health care system, 8,049 instrumented lumbar spine cases were identified between 1/1/2009 and 09/30/2013. The sample was stratified into five BMI categories. Outcomes of interest included: (I) surgical-related factors and complications; (II) health-related complications; and (III) long-term complications. Mixed linear models, conditional logistic regressions, and survival analysis using a Cox regression model were conducted controlling for surgeon effects. Age, gender, diabetes status, smoking status, admitting diagnosis, and surgical approach were included as covariates.
Every 5 kg/m increase in BMI was associated with a significant increase in surgical time (7.8 minutes), estimated blood loss (EBL) (36.5 mL), risk of deep infection (OR =1.7 times), and deep vein thrombosis (DVT) (OR =1.5). BMI was not associated with increased incidence of other intraoperative or health-related complications. Rate of re-operation was 1.1 times higher with every 5 kg/m increase in BMI, but rate of re-operation due to adjacent segment disease (ASD) was not associated with BMI.
Obesity had an adverse effect on certain surgical-related, health-related and long-term surgical outcomes. The magnitude of this effect increased with increasing levels of obesity, which increases the medical burden associated with obesity.
关于肥胖对腰椎手术预后的影响，存在相互矛盾的研究结果；结果取决于所研究的诊断、评估的手术、肥胖的定义以及所测量的具体预后指标。这项回顾性队列研究的目的是在一个具有代表性的单一患者样本中，研究体重指数（BMI）增加对腰椎手术的手术相关、健康相关及长期预后的影响。
利用一个综合医疗系统的手术登记系统，确定了2009年1月1日至2013年9月30日期间的8049例腰椎器械手术病例。样本被分为五个BMI类别。感兴趣的预后指标包括：（I）手术相关因素和并发症；（II）健康相关并发症；以及（III）长期并发症。采用混合线性模型、条件逻辑回归以及使用Cox回归模型的生存分析，并对手术医生的影响进行控制。将年龄、性别、糖尿病状态、吸烟状态、入院诊断和手术方式作为协变量纳入分析。
BMI每增加5kg/m²，手术时间显著增加（7.8分钟）、估计失血量（EBL）增加（36.5mL）、深部感染风险增加（OR = 1.7倍）以及深静脉血栓形成（DVT）风险增加（OR = 1.5）。BMI与其他术中或健康相关并发症的发生率增加无关。BMI每增加5kg/m²，再次手术率高出1.1倍，但因相邻节段疾病（ASD）导致的再次手术率与BMI无关。
肥胖对某些手术相关、健康相关及长期手术预后有不良影响。这种影响的程度随着肥胖程度的增加而增加，这增加了与肥胖相关的医疗负担。
