Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Zurich, Switzerland.
Spine (Phila Pa 1976). 2021 Sep 1;46(17):1191-1196. doi: 10.1097/BRS.0000000000004001.
Retrospective cohort studying using a national, administrative database.
The aim of this study was to determine the postoperative complications and quality outcomes of patients with and without obesity undergoing surgical management for lumbar degenerative disease (LDD).
Obesity is a global epidemic that negatively impacts health outcomes. Characterizing the effect of obesity on LDD surgery is important given the growing elderly obese population.
This study identified patients with who underwent surgery for LDD between 2007 and 2016. Patients were stratified based on whether the patient had a concurrent diagnosis of obesity at time of surgery. Propensity score matching (PSM) was then utilized to mitigate intergroup differences between patients with and without obesity. Patients who underwent three or more levels surgical correction, were under the age of 18 years, or those with any previous history of trauma or tumor were excluded from this study. Baseline comorbidities, postoperative complication rates, and reoperation rates were determined.
A total of 67,215 patients underwent primary lumbar degenerative surgery, of which 22,405 (33%) were obese. After propensity score matching, baseline covariates of the two cohorts were similar. The complication rate was 8.3% in the nonobese cohort and 10.4% in the obese cohort (P < 0.0001). Patients with obesity also had longer lengths of stay (2.7 days vs. 2.4 days, P < 0.05), and higher rates of reoperation and readmission at all time-points through the study follow-up period to their nonobese counterparts (P < 0.05). Including payments after discharge, lumbar degenerative surgery in patients with obesity was associated with higher payments throughout the 2-year follow-up period ($68,061 vs. $59,068 P < 0.05).
Patients with a diagnosis of obesity at time of LDD surgery are at a higher risk for postoperative complications, reoperation, and readmission.Level of Evidence: 4.
回顾性队列研究，使用国家行政数据库。
本研究旨在确定肥胖患者和非肥胖患者接受腰椎退行性疾病（LDD）手术治疗的术后并发症和质量结局。
肥胖是一种全球性的流行疾病，对健康结果产生负面影响。鉴于日益增长的肥胖老年人群，描述肥胖对 LDD 手术的影响非常重要。
本研究确定了 2007 年至 2016 年间接受 LDD 手术的患者。根据患者手术时是否伴有肥胖症的诊断，将患者分为两组。然后利用倾向评分匹配（PSM）来减轻肥胖患者和非肥胖患者之间的组间差异。排除了接受三级或更多级别的手术矫正、年龄在 18 岁以下或有任何既往创伤或肿瘤史的患者。确定了基线合并症、术后并发症发生率和再次手术率。
共有 67215 例患者接受了原发性腰椎退行性手术，其中 22405 例（33%）为肥胖患者。经过倾向评分匹配后，两组的基线协变量相似。非肥胖组的并发症发生率为 8.3%，肥胖组为 10.4%（P<0.0001）。肥胖患者的住院时间也更长（2.7 天比 2.4 天，P<0.05），并且在研究随访期间的所有时间点，与非肥胖患者相比，再次手术和再入院的比例更高（P<0.05）。包括出院后的付款在内，肥胖患者的腰椎退行性手术在整个 2 年随访期间的支付费用更高（68061 美元比 59068 美元，P<0.05）。
LDD 手术时诊断为肥胖的患者术后并发症、再次手术和再入院的风险更高。
4 级。
