Obesity Makes Lumbar Surgery More Risky

Obesity leads to more complications after elective lumbar spinal fusion surgery, according to a recent prospective study. The work was completed by Mark Rivkin, DO, of the Department of Neurosurgery at Cooper University Hospital in Camden, New Jersey, and was published in the Journal of Neurological Disorders.

Low back pain affects more than 80% of adults, and a growing number of people in the US have a BMI that qualifies them as either over-weight or obese. It is unsurprising that surgeons are seeing more obese individuals seeking degenerative lumbar surgery. The researchers in this study found that “trials examining the impact of BMI on complication rate specifically during these procedures are scarce.”

The researchers considered data for all patients over an 18-month period who were seen at one care center. Inclusion criteria included being over the age of 18, having elective surgery, some degenerative pathology and “lumbar instrumented posterolateral fusion procedure.” Anyone with prior lumbar surgery, infection, trauma, tumor history, or lumbar fractures was excluded. Adverse events, along with “variables such as age, gender, BMI, spinal levels of interest, estimated blood loss in milliliters, duration of procedure in minutes, and hospital length of stay” were considered as part of the study.

Steps were taken to avoid potential inclusion bias. A blinded, spine-trained nurse coordinator validated the collection of adverse events by members of the research team. Then, as an additional precaution, “any event that was felt to be a perioperative complication by a single member of the research team was included in the final analysis.”

A total of 77 patients participated; 49 were female, and 28 were male. Of them, 38 were classified as obese, with a BMI over 30, and 39 were non-obese. Ten of the non-obese patients had complications, while 19 of the obese patients had complications. “There was also a significant difference in the rate of total complications between the two groups with 13 adverse events in the non-obese and 28 events in the obese.”

Although the results of this study show that obese patients face a greater risk of perioperative complications when undergoing this particular surgery, the researchers say, “We do not advocate withholding surgical interventions based solely on BMI parameters as good long-term clinical outcomes have been demonstrated in carefully selected obese patients.” However, exploring other options, including weight loss, may be more helpful and less risky.