The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis.

STUDY DESIGN

Retrospective.

OBJECTIVE

Assess the impact of varying severity of BMI on 30-day outcomes following posterior spinal fusions in neuromuscular scoliosis.

SUMMARY OF BACKGROUND DATA

Obesity in the pediatric population is shown to be associated with adverse outcomes across varying specialties. The weight-outcome relationship in neuromuscular scoliosis has not been thoroughly investigated.

METHODS

The 2012-2016 American College of Surgeons - National Surgical Quality Improvement (ACS-NSQIP) database was queried using Current Procedural Terminology codes 22800, 22802, and 22804 to identify patients undergoing posterior spinal fusion for neuromuscular scoliosis only. BMI was classified into four groups based on the Center for Disease Control (CDC) BMI-for-age percentile chart - Normal weight (BMI ≥5th to <85th percentile), Underweight (<5th percentile), Overweight (≥85th to <95th percentile) and Obese (≥95th percentile). Multivariate regression models were built to understand the impact of varying BMI severity classes on 30-day outcomes.

RESULTS

A total of 1291 patients underwent posterior spinal fusion for neuromuscular scoliosis. A total of 695 (53.8%) were normal weight, 286 (22.2%) were underweight, 145 (11.2%) were overweight, and 165 (12.8%) were obese. Obese patients versus normal weight patients were at a significantly higher risk of surgical site infections (OR 2.15; P = 0.035), wound dehiscence (OR 1.58; P = 0.037), urinary tract infections (OR 3.41; P = 0.010), and 30-day readmissions (OR 1.94; P = 0.029). Of note, overweight versus normal weight individuals had higher odds of cardiopulmonary complications (OR 8.82; P = 0.024). No significant associations were seen for varying BMI and other 30-day outcomes.

CONCLUSIONS

Obese neuromuscular patients undergoing PSF have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions. Providers should promote prevention strategies, such as dietary modification and/or early physical activity in these high-risk patients to minimize the risks of experiencing complications in the acute postoperative period.

LEVEL OF EVIDENCE