Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, 301 E. 17th St, New York, NY 10003, USA.
Department of Orthopaedic Surgery, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada.
Spine J. 2018 Jul;18(7):1204-1210. doi: 10.1016/j.spinee.2017.11.015. Epub 2017 Nov 16.
Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood.
Identify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery.
STUDY DESIGN/SETTING: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013.
A total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine.
Complication rates.
The patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries.
Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m. The odds ratios for any complication (odds ratio [OR] [95% confidence interval {CI}]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05).
There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.
脊柱病理学中的肥胖作为一种合并症，可能会增加手术治疗后发生并发症的风险。肥胖成为临床相关的体重指数（BMI）阈值，以及确切的影响性质仍知之甚少。
确定独立预测腰椎手术后术后并发症风险的 BMI。
研究设计/背景：回顾性分析国家手术质量改进计划（NSQIP）2011-2013 年的数据。
共有 31763 例患者接受关节融合术、椎间盘切除术、椎板切除术、椎板成形术、椎体切除术或腰椎截骨术。
并发症发生率。
根据世界卫生组织的分类，患者术前按 BMI 分为以下几类：体重不足（BMI<18.5）、超重正常（BMI 20.0-29.9）、肥胖 1 级（BMI 30.0-34.9）、肥胖 2 级（BMI 35.0-39.9）和肥胖 3 级（BMI≥40）。根据其手术侵袭性指数（SII）第 75 百分位的上下位置，患者被分为低 SII 和高 SII。通过 Bonferroni 方差分析（ANOVA）方法分析 BMI 组之间并发症发生率的差异。多元二项逻辑回归评估了 BMI 与所有患者、高 SII 和低 SII 手术中并发症类别的关系。
控制 SII、Charlson 合并症指数（CCI）评分、糖尿病、高血压和吸烟的基线差异后，BMI 为 35kg/m 时，并发症显著增加。任何并发症的优势比（OR）[95%置信区间（CI）]；肥胖 2 级：1.218[1.020-1.455]；肥胖 3 级：1.742[1.439-2.110]）、感染（肥胖 2 级：1.335[1.110-1.605]；肥胖 3 级：1.685[1.372-2.069]）和手术并发症（肥胖 2 级：1.622[1.250-2.104]；肥胖 3 级：2.798[2.154-3.634]）在肥胖 2 级和 3 级患者中明显高于正常超重组（均 p<.05）。
腰椎手术后 BMI≥35 的患者并发症明显增加，特别是感染和手术并发症，而 BMI≥40 的患者并发症进一步增加。
