Introduction: Studies have associated obesity and complications in spine surgery. To our knowledge no prospective studies have analyzed this correlation in patients undergoing elective lumbar surgery at a center treating a high percentage of obese patients. In this setting the impact of obesity on complications, operative time, and length of hospitalization remains uncertain. The purpose of this study was to investigate the correlation between obesity, complications, length of stay, and operative time in elective lumbar surgery.
Methods: Patients undergoing lumbar laminectomy or laminectomy with fusion for spinal stenosis, disc herniation, or spondylolisthesis were included. Follow up of at least 12 months was required. Patients were excluded in cases of trauma, tumor, infection, emergent surgery, deformity, and pseudarthrosis. Complications included wound infection, hematoma, urinary tract infection, deep venous thrombosis, pulmonary embolism, pneumonia, myocardial infarction, death, or new neurologic deficit. Patients were defined as “obese” for BMI = 35 based on the World Health Organization definition of class II obesity. Chi-square and student-t tests were used to analyze demographics, surgical characteristics, and complications.
Results: A total of 602 patients were included with 431 (71.5%) “non-obese,” and 171 (28.5%) “obese.” The 90-day complication rate was 14.8%, with surgical site infection and UTI seen most commonly. There was no significant difference in complications (15.5% in non-obese vs. 12.9% in obese, p = 0.46). Length of hospitalization was also not statistically different between the two groups (3.75 vs. 4.2 days, p = 0.448), while operative time was significantly shorter in the non-obese group (198 vs. 214 minutes, p = 0.026).
Conclusions: In this analysis of patients undergoing lumbar surgery at a high-volume center, BMI greater than 35 was not associated with increased 90-day complications or length of stay. These findings are in contrast to some previous literature, and may suggest that complications for obese patients can be mitigated.
Patient Care: This study provides information that will be useful for surgeons in the informed consent and decision making process when treating obese patients with lumbar pathology
Learning Objectives: At the end of this session, participants should be able to 1) discuss the correlation of obesity with surgical complications in lumbar surgery. 2) Apply this information to the process of informed consent and surgical decision making with obese patients.