George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Turk Neurosurg. 2023;33(6):1047-1052. doi: 10.5137/1019-5149.JTN.43115-22.1.
To investigate the impact of obesity on postoperative morbidity and mortality in patients who underwent anterior cervical discectomy and fusion (ACDF).
The American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) files from 2006 to 2019 were queried for all patients who underwent an ACDF. Fisher exact tests were used in analyzing univariate differences in preoperative comorbidities and postoperative morbidity and mortality between patients with and without obesity (BMI ?30 kg/ m < sup > 2 < /sup > ). Results with a p value < 0.05 were considered statistically significant. Multivariable logistic regression models were used in determining the independent impact of obesity on ACDF postoperative morbidity and mortality. A p value < 0.017 was required for multivariate statistical significance.
There were 96,882 patients who underwent an ACDF from 2006 to 2019 found. 53.77% had non-obese BMI. Patients had statistically significant differences in most perioperative comorbidities and postoperative outcomes on univariate analysis. On multivariate analysis, patients with obesity has decreased adjusted odds of wound infections (aOR=0.7208, CI 0.574-0.9075, p=0.0053), pulmonary events (aOR=0.7939, CI 0.6903-0.9129, p=0.0012), sepsis (aOR=0.5670, CI 0.4359-0.7374, p=2.32E-05), transfusion requirements (aOR=0.5396, CI 0.4498-0.6473, p=3.04E-11), return to operating room (aOR=0.7537, CI 0.6727-0.8447, p=1.17E-06), and length of stay > 10 days (aOR=0.7061, CI 0.6438-0.7744, p=1.49E-13).
Obesity is a protective factor toward ACDF postoperative complications. Obesity as a marker of patient selection criteria for ACDF procedures should not be used by spine surgeons.
探讨肥胖对接受前路颈椎间盘切除融合术（ACDF）患者术后发病率和死亡率的影响。
检索 2006 年至 2019 年美国外科医师学会国家手术质量改进计划（NSQIP）档案中所有接受 ACDF 的患者。使用 Fisher 确切检验分析肥胖（BMI≥30kg/m²）和非肥胖患者术前合并症和术后发病率及死亡率的单变量差异。p 值＜0.05 认为具有统计学意义。使用多变量逻辑回归模型确定肥胖对 ACDF 术后发病率和死亡率的独立影响。多变量统计显著性的 p 值需＜0.017。
共纳入 2006 年至 2019 年接受 ACDF 的患者 96882 例，其中 53.77%的患者 BMI 正常。单变量分析显示，两组患者围手术期合并症和术后结局存在统计学显著差异。多变量分析显示，肥胖患者的手术部位感染（aOR=0.7208，CI 0.574-0.9075，p=0.0053）、肺部事件（aOR=0.7939，CI 0.6903-0.9129，p=0.0012）、脓毒症（aOR=0.5670，CI 0.4359-0.7374，p=2.32E-05）、输血需求（aOR=0.5396，CI 0.4498-0.6473，p=3.04E-11）、重返手术室（aOR=0.7537，CI 0.6727-0.8447，p=1.17E-06）和住院时间＞10 天（aOR=0.7061，CI 0.6438-0.7744，p=1.49E-13）的校正比值均降低。
肥胖是 ACDF 术后并发症的保护因素。肥胖不应作为脊柱外科医生选择 ACDF 手术患者的标准。
