Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA.
Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MU West 321, Box 0728, San Francisco, CA 94143, USA.
Spine J. 2018 Sep;18(9):1526-1532. doi: 10.1016/j.spinee.2018.01.023. Epub 2018 Feb 23.
Severely obese patients with operative spinal pathology present a challenge to the spine surgeon, given the increased complication risk.
We aimed to determine the impact of bariatric surgery (BS) on perioperative complications of posterior lumbar fusion.
This is a retrospective cohort study.
Patients undergoing posterior lumbar fusion surgery in the State Inpatient Databases of New York, Florida, North Carolina, Nebraska, Utah, and California comprised the patient sample.
Thirty-day medical complications, surgical complications (nerve injury, infection, revision), death, readmission, and hospital length of stay (LOS) were the study's outcomes.
We analyzed 156,517 patients using International Classification of Diseases, Ninth Revision codes. Patients were categorized into three groups: Group 1: history of BS and obesity, Group 2: severe obesity, body mass index (BMI)>40 (severely obese), and Group 3: normal weight, BMI<25 (non-obese). Logistic and linear multivariate regressions were performed to compare complications and LOS, respectively, between BS and severely obese groups and BS and non-obese groups while controlling for confounders. There were no sources of funding for this study.
There were 590 patients with BS, 5,791 severely obese, and 150,136 non-obese. Comparing BS with severely obese, BS had significantly lower rates of respiratory failure (odds ratio [OR] 0.59, p=.019), urinary tract infection (OR 0.64, p=.031), acute renal failure (OR 0.39, p=.007), overall medical complications (OR 0.59, p<.001), and infection (OR 0.65, p=.025). Bariatric surgery also had significantly lower hospital LOS (B=-0.46, p=.01). Comparing BS with non-obese, there were no significant differences in medical complications; however, BS had significantly higher rates of infection (OR 2.70, p<.001), reoperation (OR 2.05, p=.045), and readmission (OR 1.89, p<.001).
Bariatric surgery before elective posterior lumbar fusion mitigates risk of medical complications and infection. However, these patients still have increased risk of infection, revision surgery, and readmission compared with patients with normal BMI. Surgeons might consider referral for BS for the severely obese patient before undergoing spine surgery.
对于接受脊柱手术的严重肥胖患者，由于并发症风险增加，这对脊柱外科医生提出了挑战。
我们旨在确定减重手术（BS）对后路腰椎融合术围手术期并发症的影响。
这是一项回顾性队列研究。
患者样本来自纽约州、佛罗里达州、北卡罗来纳州、内布拉斯加州、犹他州和加利福尼亚州的州住院数据库中接受后路腰椎融合术的患者。
30 天内的医疗并发症、手术并发症（神经损伤、感染、翻修）、死亡、再入院和住院时间（LOS）是本研究的结果。
我们使用国际疾病分类，第九版代码分析了 156517 名患者。患者分为三组：第 1 组：BS 病史和肥胖症，第 2 组：严重肥胖，体重指数（BMI）>40（严重肥胖），第 3 组：正常体重，BMI<25（非肥胖）。进行逻辑和线性多元回归分析，以比较 BS 组和严重肥胖组以及 BS 组和非肥胖组之间的并发症和 LOS，同时控制混杂因素。本研究无资金来源。
BS 组有 590 例，严重肥胖组 5791 例，非肥胖组 150136 例。与严重肥胖组相比，BS 组的呼吸衰竭发生率显著降低（比值比[OR]0.59，p=.019）、尿路感染（OR 0.64，p=.031）、急性肾衰竭（OR 0.39，p=.007）、总体医疗并发症（OR 0.59，p<.001）和感染（OR 0.65，p=.025）。BS 组的住院 LOS 也明显较低（B=-0.46，p=.01）。与非肥胖组相比，BS 组在医疗并发症方面无显著差异；然而，BS 组的感染（OR 2.70，p<.001）、再次手术（OR 2.05，p=.045）和再入院（OR 1.89，p<.001）的发生率更高。
在择期后路腰椎融合术前进行减重手术可降低医疗并发症和感染的风险。然而，与 BMI 正常的患者相比，这些患者的感染、翻修手术和再入院风险仍然更高。对于接受脊柱手术的严重肥胖患者，外科医生可能会考虑在手术前转介进行 BS。
