Couch Brandon K, Fourman Mitchell S, Shaw Jeremy D, Wawrose Richard A, Talentino Spencer E, Boakye Lorraine A T, Donaldson William F, Lee Joon Y
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA.
School of Medicine, University of Pittsburgh, PA, USA.
Global Spine J. 2023 May;13(4):977-983. doi: 10.1177/21925682211011601. Epub 2021 Apr 28.
Retrospective cohort study.
To evaluate the impact of bariatric surgery on patient outcomes following elective instrumented lumbar fusion.
A retrospective review of a prospectively collected database was performed. Patients who underwent a bariatric procedure prior to an elective instrumented lumbar fusion were evaluated. Lumbar procedures were performed at a large academic medical center from 1/1/2012 to 1/1/2018. The primary outcome was surgical site infection (SSI) requiring surgical debridement. Secondary outcomes were prolonged wound drainage requiring treatment, implant failure requiring revision, revision secondary to adjacent segment disease (ASD), and chronic pain states. A randomly selected, surgeon and comorbidity-matched group of 59 patients that underwent an elective lumbar fusion during that period was used as a control. Statistical analysis was performed using Student's two-way t-tests for continuous data, with significance defined as < .05.
Twenty-five patients were identified who underwent bariatric surgery prior to elective lumbar fusion. Mean follow-up was 2.4 ± 1.9 years in the bariatric group vs. 1.5 ± 1.3 years in the control group. Patients with a history of bariatric surgery had an increased incidence of SSI that required operative debridement, revision surgery due to ASD, and a higher incidence of chronic pain. Prolonged wound drainage and implant failure were equivalent between groups.
In the present study, bariatric surgery prior to elective instrumented lumbar fusion was associated increased risk of surgical site infection, adjacent segment disease and chronic pain when compared to non-bariatric patients.
回顾性队列研究。
评估减肥手术对择期腰椎融合内固定术后患者预后的影响。
对前瞻性收集的数据库进行回顾性分析。评估在择期腰椎融合内固定术前接受减肥手术的患者。腰椎手术于2012年1月1日至2018年1月1日在一家大型学术医疗中心进行。主要结局是需要手术清创的手术部位感染（SSI）。次要结局包括需要治疗的伤口引流延长、需要翻修的植入物失败、因相邻节段疾病（ASD）进行的翻修以及慢性疼痛状态。随机选取同期接受择期腰椎融合手术的59名外科医生和合并症匹配的患者作为对照组。对连续数据采用学生双样本t检验进行统计分析，显著性定义为P< .05。
确定25例在择期腰椎融合术前接受减肥手术的患者。减肥手术组的平均随访时间为2.4±1.9年，对照组为1.5±1.3年。有减肥手术史的患者发生需要手术清创的SSI、因ASD进行翻修手术的发生率增加，慢性疼痛的发生率更高。两组之间伤口引流延长和植入物失败情况相当。
在本研究中，与未接受减肥手术的患者相比，择期腰椎融合内固定术前接受减肥手术与手术部位感染、相邻节段疾病和慢性疼痛的风险增加相关。
