Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

Alex Soroceanu, Douglas C. Burton, Bassel Georges Diebo, Justin S. Smith, Richard Hostin, Christopher I. Shaffrey, Oheneba Boachie-Adjei, Gregory M. Mundis, Christopher Ames, Thomas J. Errico, Shay Bess, Munish C. Gupta, Robert A. Hart, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

OBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

Original languageEnglish (US)
Pages (from-to)656-664
Number of pages9
JournalJournal of Neurosurgery: Spine
Volume23
Issue number5
DOIs
StatePublished - Nov 1 2015

Fingerprint

Obesity
Infection
Scoliosis
Operating Rooms
Reoperation
Research
Patient Reported Outcome Measures
Length of Stay
Wound Infection
Body Mass Index
Odds Ratio
Quality of Life
Databases
Incidence
Wounds and Injuries

Keywords

  • Adult spinal deformity
  • Complications
  • Deformity
  • Obesity
  • Outcomes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Soroceanu, A., Burton, D. C., Diebo, B. G., Smith, J. S., Hostin, R., Shaffrey, C. I., ... Lafage, V. (2015). Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. Journal of Neurosurgery: Spine, 23(5), 656-664. https://doi.org/10.3171/2015.3.SPINE14743

Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. / Soroceanu, Alex; Burton, Douglas C.; Diebo, Bassel Georges; Smith, Justin S.; Hostin, Richard; Shaffrey, Christopher I.; Boachie-Adjei, Oheneba; Mundis, Gregory M.; Ames, Christopher; Errico, Thomas J.; Bess, Shay; Gupta, Munish C.; Hart, Robert A.; Schwab, Frank J.; Lafage, Virginie.

In: Journal of Neurosurgery: Spine, Vol. 23, No. 5, 01.11.2015, p. 656-664.

Research output: Contribution to journalReview article

Soroceanu, A, Burton, DC, Diebo, BG, Smith, JS, Hostin, R, Shaffrey, CI, Boachie-Adjei, O, Mundis, GM, Ames, C, Errico, TJ, Bess, S, Gupta, MC, Hart, RA, Schwab, FJ & Lafage, V 2015, 'Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery', Journal of Neurosurgery: Spine, vol. 23, no. 5, pp. 656-664. https://doi.org/10.3171/2015.3.SPINE14743
Soroceanu, Alex ; Burton, Douglas C. ; Diebo, Bassel Georges ; Smith, Justin S. ; Hostin, Richard ; Shaffrey, Christopher I. ; Boachie-Adjei, Oheneba ; Mundis, Gregory M. ; Ames, Christopher ; Errico, Thomas J. ; Bess, Shay ; Gupta, Munish C. ; Hart, Robert A. ; Schwab, Frank J. ; Lafage, Virginie. / Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. In: Journal of Neurosurgery: Spine. 2015 ; Vol. 23, No. 5. pp. 656-664.
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abstract = "OBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.",
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T1 - Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

AU - Soroceanu, Alex

AU - Burton, Douglas C.

AU - Diebo, Bassel Georges

AU - Smith, Justin S.

AU - Hostin, Richard

AU - Shaffrey, Christopher I.

AU - Boachie-Adjei, Oheneba

AU - Mundis, Gregory M.

AU - Ames, Christopher

AU - Errico, Thomas J.

AU - Bess, Shay

AU - Gupta, Munish C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Lafage, Virginie

PY - 2015/11/1

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N2 - OBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

AB - OBJECT: Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS: This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS: Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement over time, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS: This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

KW - Adult spinal deformity

KW - Complications

KW - Deformity

KW - Obesity

KW - Outcomes

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