Feeley Aoife, McDonnell Jake, Feeley Iain, Butler Joseph
Department of Orthopaedics, 58000Midlands Regional Hospital Tullamore, Tullamore, Ireland.
School of Medicine, 8863Royal College of Surgeons Ireland, Dublin, Ireland.
Global Spine J. 2022 Oct;12(8):1894-1903. doi: 10.1177/21925682211072849. Epub 2022 Feb 22.
Systematic Review and Meta-analysis.
Raised patient BMI is recognised as a relative contraindication to posterior lumbar interbody fusion (PLIF) due to the anaesthetic challenges, difficult positioning and increased intraoperative and postoperative complications, with the relative risk rising in patients with a BMI >25 kg/m2. The impact of obesity defined as a BMI > 30 kg/m on Anterior Lumbar Interbody Fusion (ALIF) outcomes is not yet established. The aim of this review was to evaluate if the presence of a raised BMI in patients undergoing ALIF procedures was an independent risk factor for intra- and postoperative complications.
A systematic review of search databases PubMed; Google Scholar and OVID Medline was made to identify studies related to complications in patients with increased body mass index during anterior lumbar interbody fusion. PRISMA guidelines were utilised for this review. Complication rates in raised BMI patient cohort was compared to normal BMI complication rates with meta-analysis where available.
315 articles returned with search criteria applied. Six articles were included for review, with 2190 patients included for analysis. Vascular complications in obese vs. non-obese patients undergoing the anterior approach demonstrate no significant difference in complication rates ( = .62; CI = -.03-.02). Obesity is found to result in an increased rate of overall complications ( = .002; CI = .04-.16).
Obesity was demonstrated to have an impact on overall complication rates in Anterior Lumbar Interbody Fusion procedures, with postoperative complications including wound infections and lower fusion rates more common in patients in increased BMIs. Increased focus on patient positioning and reporting of outcomes in this patient cohort is warranted to further evaluate perioperative complications.
系统评价与荟萃分析。
由于麻醉挑战、体位摆放困难以及术中及术后并发症增加，患者体重指数（BMI）升高被认为是腰椎后路椎间融合术（PLIF）的相对禁忌证，BMI>25 kg/m² 的患者相对风险增加。肥胖（定义为BMI>30 kg/m²）对腰椎前路椎间融合术（ALIF）结果的影响尚未明确。本综述的目的是评估接受ALIF手术的患者BMI升高是否是术中和术后并发症的独立危险因素。
对搜索数据库PubMed、谷歌学术和OVID医学在线进行系统评价，以识别与腰椎前路椎间融合术期间体重指数增加患者的并发症相关的研究。本综述采用PRISMA指南。将BMI升高患者队列中的并发症发生率与正常BMI患者的并发症发生率进行比较，并在可行的情况下进行荟萃分析。
应用搜索标准后返回315篇文章。纳入6篇文章进行综述，纳入2190例患者进行分析。接受前路手术的肥胖患者与非肥胖患者的血管并发症发生率无显著差异（P = 0.62；可信区间[CI]=-0.03-0.02）。发现肥胖会导致总体并发症发生率增加（P = 0.002；CI = 0.04-0.16）。
肥胖被证明对腰椎前路椎间融合术的总体并发症发生率有影响，术后并发症包括伤口感染和融合率较低在BMI升高的患者中更为常见。有必要更加关注该患者队列的体位摆放和结果报告，以进一步评估围手术期并发症。
