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

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

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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., Boachie-Adjei, O., Mundis, G. M., Ames, C., Errico, T. J., Bess, S., Gupta, M. C., Hart, R. A., Schwab, F. J., & 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