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Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regard...

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Autores principales: Ranson, William A., Cheung, Zoe B., Di Capua, John, Lee, Nathan J., Ukogu, Chierika, Jacobs, Samantha, Vig, Khushdeep S., Kim, Jun S., White, Samuel J. W., Cho, Samuel K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293430/
https://www.ncbi.nlm.nih.gov/pubmed/30560030
http://dx.doi.org/10.1177/2192568218771363
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author Ranson, William A.
Cheung, Zoe B.
Di Capua, John
Lee, Nathan J.
Ukogu, Chierika
Jacobs, Samantha
Vig, Khushdeep S.
Kim, Jun S.
White, Samuel J. W.
Cho, Samuel K.
author_facet Ranson, William A.
Cheung, Zoe B.
Di Capua, John
Lee, Nathan J.
Ukogu, Chierika
Jacobs, Samantha
Vig, Khushdeep S.
Kim, Jun S.
White, Samuel J. W.
Cho, Samuel K.
author_sort Ranson, William A.
collection PubMed
description STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regarding additional risk factors that further predispose this already high-risk patient population to poor surgical outcomes following elective posterior lumbar fusion (PLF). The aim of the study is to identify independent risk factors for poor 30-day perioperative outcomes in morbidly obese patients undergoing elective PLF. METHODS: We identified 22 909 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective PLF. There were 1861 morbidly obese patients. Baseline patient demographics and medical comorbidities were collected. Univariate analysis was performed to compare perioperative complication rates between non-morbidly obese and morbidly obese patients. The 5 most common complications in the morbidly obese group were then selected for multivariate regression analysis to identify independent risk factors for poor 30-day outcomes. RESULTS: Morbidly obese patients had a higher perioperative complication rate. The 5 most common complications were prolonged hospitalization, blood transfusion, readmission, wound complications, and reoperation. Independent risk factors for these complications were age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4 levels, and extended operative time (ie, operative time ≥318 minutes). CONCLUSIONS: Morbidly obese patients are at higher risk of perioperative complications following elective PLF. Modifiable risk factors for the most common complications are obesity and preoperative steroid use.
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spelling pubmed-62934302018-12-17 Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion Ranson, William A. Cheung, Zoe B. Di Capua, John Lee, Nathan J. Ukogu, Chierika Jacobs, Samantha Vig, Khushdeep S. Kim, Jun S. White, Samuel J. W. Cho, Samuel K. Global Spine J Original Articles STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The prevalence of obesity-related low back pain and degenerative disc disease is on the rise. Past studies have demonstrated that obesity is associated with higher perioperative complication rates, but there remains a gap in the literature regarding additional risk factors that further predispose this already high-risk patient population to poor surgical outcomes following elective posterior lumbar fusion (PLF). The aim of the study is to identify independent risk factors for poor 30-day perioperative outcomes in morbidly obese patients undergoing elective PLF. METHODS: We identified 22 909 patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent elective PLF. There were 1861 morbidly obese patients. Baseline patient demographics and medical comorbidities were collected. Univariate analysis was performed to compare perioperative complication rates between non-morbidly obese and morbidly obese patients. The 5 most common complications in the morbidly obese group were then selected for multivariate regression analysis to identify independent risk factors for poor 30-day outcomes. RESULTS: Morbidly obese patients had a higher perioperative complication rate. The 5 most common complications were prolonged hospitalization, blood transfusion, readmission, wound complications, and reoperation. Independent risk factors for these complications were age ≥65 years, super obesity (ie, BMI > 48.6), chronic steroid use, American Society of Anesthesiology classification ≥3, poor functional status, long length of fusion ≥4 levels, and extended operative time (ie, operative time ≥318 minutes). CONCLUSIONS: Morbidly obese patients are at higher risk of perioperative complications following elective PLF. Modifiable risk factors for the most common complications are obesity and preoperative steroid use. SAGE Publications 2018-04-22 2018-12 /pmc/articles/PMC6293430/ /pubmed/30560030 http://dx.doi.org/10.1177/2192568218771363 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Articles
Ranson, William A.
Cheung, Zoe B.
Di Capua, John
Lee, Nathan J.
Ukogu, Chierika
Jacobs, Samantha
Vig, Khushdeep S.
Kim, Jun S.
White, Samuel J. W.
Cho, Samuel K.
Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title_full Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title_fullStr Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title_full_unstemmed Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title_short Risk Factors for Perioperative Complications in Morbidly Obese Patients Undergoing Elective Posterior Lumbar Fusion
title_sort risk factors for perioperative complications in morbidly obese patients undergoing elective posterior lumbar fusion
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293430/
https://www.ncbi.nlm.nih.gov/pubmed/30560030
http://dx.doi.org/10.1177/2192568218771363
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