Obesity and perioperative adverse events in patients undergoing complex revision surgery for the thoracolumbar spine

Takashi Hirase; Jeremiah F Ling; Varan Haghshenas; Richard Fuld 3rd; David Dong; Darrell S Hanson; B Christoph Meyer; Rex A W Marco

doi:10.1186/s12891-022-05505-4

Obesity and perioperative adverse events in patients undergoing complex revision surgery for the thoracolumbar spine

BMC Musculoskelet Disord. 2022 Jun 4;23(1):534. doi: 10.1186/s12891-022-05505-4.

Authors

Takashi Hirase^{1

2}, Jeremiah F Ling³, Varan Haghshenas⁴, Richard Fuld 3rd⁴, David Dong⁴, Darrell S Hanson⁴, B Christoph Meyer⁴, Rex A W Marco⁴

Affiliations

¹ Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, 77030, USA. thirase@houstonmethodist.org.
² Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA. thirase@houstonmethodist.org.
³ Texas A&M University Health Science Center College of Medicine, 8447 Riverside Pkwy, Bryan, TX, 77807, USA.
⁴ Department of Orthopedics and Sports Medicine, Houston Methodist Hospital, 6445 Main St Suite 2500, Houston, TX, 77030, USA.

Abstract

Background: There are no previous studies that evaluate the effect of obesity on patients undergoing complex revision thoracolumbar spine surgery. The primary objective was to determine the relationship between obesity and perioperative adverse events (AEs) with patients undergoing complex revision thoracolumbar spine surgery while controlling for psoas muscle index (PMI) as a confounding variable. The secondary objective was to determine the relationship between obesity and 30-day readmission rates, 30-day re-operation rates, rate of discharge to a facility, and post-operative length of stay (LOS).

Methods: Between May 2016 and February 2020, a retrospective analysis of individuals undergoing complex revision surgery of the thoracolumbar spine was performed at a single institution. Obesity was defined as BMI ≥ 30.0 kg/m². PMI < 500 mm²/m² for males and < 412 mm²/m² for females were used to define low muscle mass. A Spine Surgical Invasiveness Index (SSII) > 10 was used to define complex revision surgery. A multivariable logistic regression model was used to ascertain the effects of low muscle mass, obesity, age, and gender on the likelihood of the occurrence of any AE.

Results: A total of 114 consecutive patients were included in the study. Fifty-four patients were in the obese cohort and 60 patients in the non-obese cohort. There was not a significant difference in perioperative outcomes of both the obese and non-obese patients. There were 22 obese patients (40.7%) and 33 non-obese patients (55.0%) that experienced any AE (p = 0.130). Multivariable analysis demonstrated that individuals with low muscle mass had a significantly higher likelihood for an AE than individuals with normal or high muscle mass (OR: 7.53, 95% CI: 3.05-18.60). Obesity did not have a significant effect in predicting AEs.

Conclusions: Obesity is not associated with perioperative AEs, 30-day readmission rates, 30-day re-operation rates, rate of discharge to a facility, or post-operative length of stay (LOS) among patients undergoing complex revision thoracolumbar spine surgery.

Level of evidence: III.

Keywords: Complex; Low muscle mass; Obesity; Predictor; Revision thoracolumbar spine surgery.

MeSH terms

Female
Humans
Male
Obesity / complications
Obesity / diagnosis
Obesity / epidemiology
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Postoperative Complications* / surgery
Reoperation
Retrospective Studies
Spine* / surgery