Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT 06511, USA.
Spine J. 2020 Jul;20(7):1085-1095. doi: 10.1016/j.spinee.2020.03.007. Epub 2020 Mar 16.
Past studies have focused on the association of high body mass index (BMI) on spine surgery outcomes. These investigations have reported mixed conclusions, possible due to insufficient power, poor controlling of confounding variables, and inconsistent definitions of BMI categories (e.g. underweight, overweight, and obese). Few studies have considered outcomes of patients with low BMI.
To analyze how anterior cervical spine surgery outcomes track with World Health Organization categories of BMI to better assess where along the BMI spectrum patients are at risk for adverse perioperative outcomes.
DESIGN/SETTING: Retrospective cohort study.
Patients undergoing elective anterior cervical spine surgery were abstracted from the 2005 to 2016 American College of Surgeons National Surgical Quality Improvement Program database.
Thirty-day adverse events, hospital readmissions, postoperative infections, and mortality.
Patients undergoing anterior cervical spine procedures (anterior cervical discectomy and fusion, anterior cervical corpectomy, cervical arthroplasty) were identified in the 2005 to 2016 National Surgical Quality Improvement Program database. Patients were then aggregated into modified World Health Organization categories of BMI. Odds ratios of adverse outcomes, normalized to average risk of normal weight subjects (BMI 18.5-24.9 kg/m), were calculated. Multivariate analyses were then performed on aggregated adverse outcome categories controlling for demographics (age, sex, functional status) and overall health as measured by the American Society of Anesthesiologists classification.
In total, 51,149 anterior cervical surgery patients met inclusion criteria. Multivariate analyses revealed the odds of any adverse event to be significantly elevated for underweight and super morbidly obese patients (Odds Ratios [OR] of 1.62 and 1.55, respectively). Additionally, underweight patients had elevated odds of serious adverse events (OR=1.74) and postoperative infections (OR=1.75) and super morbidly obese patients had elevated odds of minor adverse events (OR=1.72). Relative to normal BMI patients, there was no significant elevation for any adverse outcomes for any of the other overweight/obese categories, in fact some had reduced odds of various adverse outcomes.
Underweight and super morbidly obese patients have the greatest odds of adverse outcomes after anterior cervical spine surgery. The current study identifies underweight patients as an at-risk population that has previously not received significant focus. Physicians and healthcare systems should give additional consideration to this population, as they often already do for those at the other end of the BMI spectrum.
过去的研究集中在高身体质量指数（BMI）对脊柱手术结果的影响。这些研究的结论不一，可能是由于研究的样本量不足、混杂因素控制不当以及 BMI 分类（如体重过轻、超重和肥胖）的定义不一致。很少有研究考虑 BMI 较低的患者的手术结果。
分析前路颈椎手术结果与世界卫生组织 BMI 分类的关系，以便更好地评估患者在 BMI 谱中的哪些位置存在围手术期不良结局的风险。
设计/设置：回顾性队列研究。
从 2005 年至 2016 年美国外科医师学会国家手术质量改进计划数据库中提取接受择期前路颈椎手术的患者。
30 天内不良事件、医院再入院、术后感染和死亡率。
在 2005 年至 2016 年国家手术质量改进计划数据库中确定接受前路颈椎手术（前路颈椎间盘切除术和融合术、前路颈椎切除术、颈椎关节置换术）的患者。然后将患者归入改良的世界卫生组织 BMI 分类。计算不良结局的比值比（OR），归一化为正常体重患者（BMI 18.5-24.9kg/m2）的平均风险。然后对汇总的不良结局类别进行多变量分析，控制人口统计学因素（年龄、性别、功能状态）和美国麻醉医师协会分类衡量的整体健康状况。
共有 51149 例前路颈椎手术患者符合纳入标准。多变量分析显示，体重过轻和超级肥胖患者发生任何不良事件的风险显著升高（OR 分别为 1.62 和 1.55）。此外，体重过轻的患者发生严重不良事件（OR=1.74）和术后感染（OR=1.75）的风险升高，超级肥胖患者发生轻微不良事件（OR=1.72）的风险升高。与正常 BMI 患者相比，其他超重/肥胖类别中任何不良结局的风险均无显著升高，实际上有些类别的不良结局风险降低。
前路颈椎手术后，体重过轻和超级肥胖患者的不良结局风险最大。本研究确定体重过轻的患者为一个以前未受到关注的高危人群。医生和医疗保健系统应更加关注这一人群，因为他们通常已经关注到 BMI 谱另一端的人群。
