Joseph Jacob R, Neva Jennifer, Smith Brandon W, Strasser Mary O, Park Paul
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Int J Spine Surg. 2019 Feb 22;13(1):24-27. doi: 10.14444/6003. eCollection 2019 Jan.
Extreme obesity (class III) is defined by the Centers for Disease Control as a body mass index (BMI) value ≥40. Recent studies suggest that obese patients have poor outcomes after thoracolumbar spinal fusions. The objective of this study was to analyze 30-day adverse events and patient-reported outcomes (PROs) for this population.
A retrospective chart review of spinal fusion surgeries performed at a single institution from 2006 to 2016 was executed. All patients had a preoperative BMI ≥40. Patient characteristics, including age, sex, BMI, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and others, were collected. Thirty-day adverse events (complications, readmissions, reoperations, and mortality) and PROs (Oswestry Disability Index [ODI] and visual analog scale [VAS]) were recorded.
Fifty-six patients were identified, including 30 men (54%). Mean age was 55.7 years (range, 31-74 years). Mean BMI was 44.2 (range, 40.0-54.7). Mean ASA was 2.7 (range, 2-3), and mean CCI was 1.1 (range, 0-6). Mean number of fused levels was 2.3 (range, 1-14). Mean length of stay was 4.4 ± 2.1 days. Mean number of complications was 0.7 ± 1.1, with 30.4% of patients having had at least 1 complication. The 30-day all-cause readmission rate was 5.4%, and 30-day reoperation rate was 3.6%. For 30 patients (54%) with 1-year PROs, mean preoperative ODI was 65.2 ± 11.1, and mean preoperative VAS was 6.6 ± 1.6. Mean ODI change was -19.9 ± 20.1 ( < .001), and mean VAS change was -2.6 ± 2.3 ( < .001). A total of 15 patients (50%) achieved the minimum clinically important difference in ODI (12.8), with a mean follow-up of 18.9 months.
Patients with extreme obesity who undergo thoracolumbar fusion have acceptable 30-day adverse events and potentially can achieve significant improvement in pain and disability.
美国疾病控制中心将极度肥胖（III 级）定义为体重指数（BMI）值≥40。近期研究表明，肥胖患者在胸腰椎融合术后预后较差。本研究的目的是分析该人群的 30 天不良事件及患者报告结局（PROs）。
对 2006 年至 2016 年在单一机构进行的脊柱融合手术进行回顾性病历审查。所有患者术前 BMI≥40。收集患者特征，包括年龄、性别、BMI、美国麻醉医师协会（ASA）评分、Charlson 合并症指数（CCI）等。记录 30 天不良事件（并发症、再入院、再次手术和死亡率）及 PROs（Oswestry 功能障碍指数[ODI]和视觉模拟评分[VAS]）。
共纳入 56 例患者，其中男性 30 例（54%）。平均年龄为 55.7 岁（范围 31 - 74 岁）。平均 BMI 为 44.2（范围 40.0 - 54.7）。平均 ASA 评分为 2.7（范围 2 - 3），平均 CCI 为 1.1（范围 0 - 6）。平均融合节段数为 2.3（范围 1 - 14）。平均住院时间为 4.4±2.1 天。平均并发症数为 0.7±1.1，30.4%的患者至少发生 1 种并发症。30 天全因再入院率为 5.4%，30 天再次手术率为 3.6%。对于 30 例（54%）有 1 年 PROs 的患者，术前平均 ODI 为 65.2±11.1，术前平均 VAS 为 6.6±1.6。ODI 平均变化为 -19.9±20.1（P <.001），VAS 平均变化为 -2.6±2.3（P <.001）。共有 15 例患者（50%）达到 ODI 的最小临床重要差异（12.8），平均随访 18.9 个月。
接受胸腰椎融合术的极度肥胖患者 30 天不良事件可接受，且疼痛和功能障碍可能有显著改善。
