Villavicencio Alan, Lee Nelson E, Rajpal Sharad, Vivek Niketna, Burneikiene Sigita
Boulder Neurosurgical Associates, Boulder, CO, United States; Justin Parker Neurological Institute, Boulder, CO, United States.
Boulder Neurosurgical Associates, Boulder, CO, United States.
Clin Neurol Neurosurg. 2019 Apr;179:19-22. doi: 10.1016/j.clineuro.2019.02.012. Epub 2019 Feb 11.
Obesity affects not only the health of an individual but society as a whole and especially the healthcare system. Healthcare providers are faced with challenges to deliver adequate care in this resource-limited environment, assure safety, and accommodate the increasing population of overweight patients. The effects of increased body mass index (BMI) on clinical outcomes, complications, health care resource utilization, effectiveness of minimally invasive approaches, and perioperative parameters in spine surgeries have all been previously studied, but the majority of these findings are conflicting rather than conclusive. The main objective of this study was to analyze the impact of BMI on perioperative outcomes in patients undergoing one- to two-level elective TLIF procedures for degenerative spine conditions and to identify the need to modify internal hospital operational planning, team organization, and patient flow processes to accommodate patients who are overweight.
A single-center retrospective case-review study was completed. The study included 172 consecutive patients who underwent elective one- or two-level transforaminal lumbar interbody fusions (TLIF). The patients were categorized as obese if they had BMI value that was equal to or greater than 30 kg/m. Outcome measures included surgical and non-operative operating room (OR) time, length of stay (LOS), and estimated blood loss (EBL). Multiple regression analyses were performed to determine if BMI had an effect on perioperative parameters while controlling for independent variables.
BMI did not have a statistically significant effect on surgical (p = 0.13) and non-operative OR time (p = 0.82). Obese patients remained hospitalized on average 0.45 ± 0.25 days longer (p = 0.037) and lost 71.8 ± 26.3 mL more blood (p = 0.007).
Obesity is associated with longer hospitalization and more intraoperative blood loss, but may have no impact on surgical and non-operative OR times in patients undergoing one- and two-level TLIFs.
肥胖不仅影响个人健康，还会对整个社会尤其是医疗保健系统产生影响。在这种资源有限的环境中，医疗服务提供者面临着提供充分护理、确保安全以及接纳日益增多的超重患者的挑战。先前已经对体重指数（BMI）增加对脊柱手术的临床结局、并发症、医疗资源利用、微创方法的有效性以及围手术期参数的影响进行了研究，但这些研究结果大多相互矛盾而非确凿无疑。本研究的主要目的是分析BMI对因退行性脊柱疾病接受一至两级选择性经椎间孔腰椎椎间融合术（TLIF）患者围手术期结局的影响，并确定是否需要修改医院内部运营规划、团队组织和患者流程，以接纳超重患者。
完成了一项单中心回顾性病例审查研究。该研究纳入了172例连续接受选择性一或两级经椎间孔腰椎椎间融合术（TLIF）的患者。如果患者的BMI值等于或大于30 kg/m²，则被归类为肥胖。结局指标包括手术和非手术手术室（OR）时间、住院时间（LOS）和估计失血量（EBL）。进行了多元回归分析，以确定在控制自变量的情况下BMI是否对围手术期参数有影响。
BMI对手术（p = 0.13）和非手术OR时间（p = 0.82）没有统计学上的显著影响。肥胖患者平均住院时间延长0.45±0.25天（p = 0.037），失血量多损失71.8±26.3 mL（p = 0.007）。
肥胖与住院时间延长和术中失血量增加有关，但可能对接受一至两级TLIF手术的患者的手术和非手术OR时间没有影响。
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