Introduction: Previous studies have investigated correlations between obesity and complications in thoracolumbar spine surgery. To our knowledge no prospective studies have analyzed the direct effect of obesity on complications in patients undergoing elective cervical surgery.
Methods: Patients undergoing elective anterior cervical discectomy and fusion were evaluated. Follow up of at least 12 months was required. Patients were excluded for trauma, tumor, infection, urgent/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-squared tests were used to analyze demographics, surgical characteristics, and complications. Complications were tracked by electronic medical record and telephone interview.
Results: A total of 299 patients were included with 219 (73%) BMI = 35, and 80 (27%) with BMI > 35. The overall 90-day complication rate was 6%. There was no difference in complications between groups: BMI = 35 had 15 (6.8%) complications, compared with 5 (6.2%) in the BMI > 35 group (p = 0.78). UTI and surgical site infection were the most common complications (3 incidents each); others included hematoma, new neurologic deficits, and hardware failure. Length of stay was slightly lower in the BMI = 35 group (1.3 vs 1.7 days, p = 0.056). Operative time in non-obese was less but did not reach statistical significance (158 vs. 173 minutes, p = 0.11).
Conclusions: In this analysis of prospective data from patients undergoing elective cervical surgery, BMI greater than 35 was not associated with increased 90-day complications. Length of stay was found to be slightly longer in the obese group. These findings suggest that obesity may not contribute to increased surgery-related complications following ACDF.
Patient Care: This data will allow surgeons to improve the process of informed consent and surgical decision making when treating obese patients with cervical pathology.
Learning Objectives: At the end of this session, participants should be able to 1) discuss the association of obesity with complications following ACDF. 2) Apply this information to the process of informed consent and surgical decision making.