Goheer Haseeb E, Hendrix Christopher G, Samuel Linsen T, Newcomb Alden H, Carmouche Jonathan J
Virginia Tech Carilion School of Medicine, 2 Riverside Circle, Roanoke, VA 24016, USA.
Department of Orthopaedic Surgery, Institute for Orthopaedics & Neurosciences, Carilion Clinic, 2331 Franklin Road Southwest, Roanoke, VA 24014, USA.
Spine J. 2025 Feb;25(2):299-305. doi: 10.1016/j.spinee.2024.09.028. Epub 2024 Sep 26.
Over the past decade, the prevalence of obesity has risen in the United States, in parallel with the demand for anterior cervical discectomy with fusion (ACDF). Prior studies have evaluated the role of obesity classes in cervical spine surgery in smaller patient populations. We aimed to evaluate any potential correlation to a national population sample by utilizing a large multicenter database.
The purpose of this study was to analyze obesity level's influence on perioperative complication rates in patients undergoing ACDF.
STUDY DESIGN/SETTING: A retrospective cohort, large multicenter database study.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify patients who had undergone an elective ACDF procedure between 2011 and 2020 using Current Procedural Terminology (CPT) code 22551.
Medical and surgical complications within thirty days of operation.
Patients were categorized into four BMI groups: nonobese (BMI 18.5-29.9 kg/m), obese class I (BMI 30-34.9 kg/m), obese class II (BMI 35-39.9 kg/m), and obese class III (BMI ≥40 kg/m). A univariate analysis conducted for demographic variables and preoperative comorbidities identified age, sex, race, smoking status, hypertension requiring medication, diabetes, history of congestive heart failure, history of bleeding disorder, and chronic obstructive pulmonary disease as risk factors. Chi-square test was used to compare incidence of complications among groups. A multivariable logistic regression analysis was subsequently performed to adjust for these preoperative risk factors and compare obesity classes I-III to nonobese patients.
About 64,718 patients were identified of whom 33,365 were nonobese, 17,190 were obese class I, 8,608 were obese class II, and 5,555 were obese class III. Obese classes I-III patients had a higher incidence of surgical site infections (0. 33%, 0.36%, 0.41%, vs 0.24%, p=.039) and pulmonary embolism (PE) (0.25%, 0.31, 0.29 vs 0.15%, p=.003). Obese classes I-III had a lower incidence of blood transfusion (0.23%, 0.17%, 0.27% vs 0.4%, p<.001) obese class I, obese class II, and obese class III independently increased the risk for PE (OR: 1.716, 95% CI (1.129-2.599); OR: 2.213, 95% CI (1.349-3.559); OR: 2.207, 95% CI (1.190--3.892), respectively).
Risk for postoperative PEs after an ACDF was significantly higher for obese classes I-III compared to nonobese patients. These findings may further support the use of additional prophylaxis measures and precaution in the perioperative setting.
在过去十年中，美国肥胖症的患病率有所上升，与此同时，颈椎前路椎间盘切除融合术（ACDF）的需求也在增加。先前的研究在较小的患者群体中评估了肥胖类别在颈椎手术中的作用。我们旨在通过利用一个大型多中心数据库来评估与全国人口样本的任何潜在相关性。
本研究的目的是分析肥胖程度对接受ACDF手术患者围手术期并发症发生率的影响。
研究设计/设置：一项回顾性队列、大型多中心数据库研究。
查询美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，以识别2011年至2020年间使用当前手术操作术语（CPT）代码22551接受择期ACDF手术的患者。
术后30天内的医疗和手术并发症。
将患者分为四个BMI组：非肥胖（BMI 18.5-29.9 kg/m）、I级肥胖（BMI 30-34.9 kg/m）、II级肥胖（BMI 35-39.9 kg/m）和III级肥胖（BMI≥40 kg/m）。对人口统计学变量和术前合并症进行单因素分析，确定年龄、性别、种族、吸烟状况、需要药物治疗的高血压、糖尿病、充血性心力衰竭病史、出血性疾病史和慢性阻塞性肺疾病为危险因素。采用卡方检验比较各组并发症的发生率。随后进行多变量逻辑回归分析，以调整这些术前危险因素，并将I-III级肥胖患者与非肥胖患者进行比较。
共识别出约64718例患者，其中33365例为非肥胖，17190例为I级肥胖，8608例为II级肥胖，5555例为III级肥胖。I-III级肥胖患者手术部位感染（0.33%、0.36%、0.41%，对比0.24%，p = 0.039）和肺栓塞（PE）（0.25%、0.31、0.29对比0.15%，p = 0.003）的发生率较高。I-III级肥胖患者输血发生率较低（0.23%、0.17%、0.27%对比0.4%，p < 0.001）。I级肥胖、II级肥胖和III级肥胖独立增加PE风险（OR：1.716，95%CI（1.129-2.599）；OR：2.213，95%CI（1.349-3.559）；OR：2.207，95%CI（1.190-3.892））。
与非肥胖患者相比，I-III级肥胖患者ACDF术后发生PE的风险显著更高。这些发现可能进一步支持在围手术期使用额外的预防措施和预防手段。
