Elsevier

World Neurosurgery

Volume 111, March 2018, Pages e374-e385
World Neurosurgery

Original Article
Does Obesity Affect Perioperative and Postoperative Morbidity and Complication Rates After Minimal Access Spinal Technologies in Surgery for Lumbar Degenerative Disc Disease

https://doi.org/10.1016/j.wneu.2017.12.075Get rights and content

Objective

The impact of obesity on spine surgery has been studied extensively, but only a few investigations have been focused on minimally invasive spinal fusion techniques and complication rates in normal-weight, preobese, or obese patients. Obesity was found to be a risk factor for intraoperative complications. Published data tend to favor minimal access surgery techniques (MAST) for obese patients. In a prospective study, we assessed the perioperative and postoperative complications of MAST in a large population of 187 patients.

Methods

We evaluated perioperative and postoperative complication rates in minimally invasive surgery (MIS) fusion techniques of the lumbar spine in obese, preobese, and normal-weight patients, classified by body mass index (BMI). Lumbar MIS fusion was performed by interbody fusion procedures and posterolateral fusion. In cases of spinal stenosis, a laminotomy was performed (146 patients). Any harmful event occurring during or after surgery was included in the statistical analysis.

Results

No infection or severe wound healing disorder was encountered in the series. No significant difference in terms of cerebrospinal fluid leakage, blood loss, drainage, or length of hospital stay between the 3 BMI groups was encountered. More clinically insignificant hematomas were encountered in the preobese and obese groups (P = 0.013) than in the normal-weight patients. No significant difference was registered between the BMI or age groups regarding overall complication rates.

Conclusion

We conclude that preobese and obese patients are good candidates for MAST because BMI did not affect complication rates or duration of surgery.

Introduction

According to the World Health Organzation, the number of obese persons has doubled since 1980. Obesity has an impact on morbidity and mortality: a BMI ≥35 appears to be associated with higher mortality rates.1 Between 1986 and 2006, 26.8% of black women and 15.6% of white men in the United States died of conditions associated with obesity.2 Obesity also influences the cost of public health services.3 Studies addressing perioperative complication rates in minimally invasive surgery (MIS) techniques by the posterior approach are scarce. Obesity was found to increase the risk of wound infection in open spine surgery.4, 5 The posterior approach to the spine is also associated with a higher risk of infection in these patients.6 MIS is believed to provide a smaller corridor to the spine and results in less soft tissue injury. MIS procedures are associated with less blood loss, faster recovery, and fewer perioperative complications.7, 8, 9 The purpose of the present study was to evaluate perioperative and postoperative morbidity in obese and nonobese patients undergoing lumbar fusion performed by minimal access surgery techniques (MAST) to determine the feasibility and safety of this procedure for preobese and obese patients.

Section snippets

Methods

The study was approved by the ethics committee of Land Niederoesterreich. One hundred eighty-seven patients were recruited for a prospective investigation. Written informed consent was obtained from all patients. Obesity was classified according to the body mass index (BMI) established by the World Health Organization, calculated by dividing a person's mass by the square of his/her height (BMI = kg/m2). Persons with a BMI <25 are considered to be of normal weight, those with a BMI ≥25 and <30

Results

The dataset included 187 patients who had undergone surgery; 115 were women and 72 were men. Thirty had a BMI ≤25 (group 01, normal weight), 79 a BMI ≥25, and ≤30 (group 02, preobese), and 78 a BMI ≥30 (group 03, obese). The distribution of BMI in men and women was similar (P = 0.29). Figure 1 shows the BMI distribution by sex and the number of patients per BMI group. The mean age was 64.27 years. Age distributions in the BMI groups did not differ significantly (P=0.7; 0.89/0.62 only taking

Discussion

A large number of publications have addressed obesity and complication rates in surgery, including spine surgery. The quantification of obesity has also been extensively discussed in recent years. Waisbren et al.16 considered percentage of body fat (%BF) to be a good predictor of surgical site infection (SSI); the authors noted that obese patients as defined by %BF (25%BF for men and 31%BF for women) were 5 times more likely to experience SSI after surgery than were nonobese patients. Mehta

Conclusion

The present study—to our knowledge comprising one of the largest cohort of patients at a single center—revealed no difference between patients with a BMI <25 and those with a BMI >25 with regard to complications associated with MAST treatment. We conclude that MAST is a feasible and safe treatment for preobese and obese patients.

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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