title: Lumbar spine fusion in obese and morbidly obese patients.
abstract: METHODS
  Single-center retrospective study.
  
  
  OBJECTIVE
  The aim of the study was to compare the surgical experience, clinical outcomes, and effect on body weight between obese and morbidly obese patients undergoing lumbar spine fusion surgery.
  
  
  BACKGROUND
  Obese and morbidly obese patients undergoing spinal fusion surgery are a challenge to the operating surgeon. Only few reports are available on the perioperative data in this group of patients. Further, it is unknown if the degree of obesity has an effect on the surgical experience and clinical outcomes including body weight.
  
  
  METHODS
  A retrospective study of 63 patients undergoing lumbar spinal fusion was carried out. The main inclusion criteria were a body mass index (BMI) equal to or greater than 30. Information recorded included surgical set-up time, surgical time, blood loss, American Association of Anesthesiologists score, and surgical complications. At follow-up, the Oswestry Disability Index and visual analog scale for back and leg pain were recorded along with a pain diagram and radiographic evaluation.
  
  
  RESULTS
  The obese group had lower American Association of Anesthesiologists scores. The surgical time was dependent on the number of levels fused and was independent of the BMI. Blood loss during surgery was marginally greater in the obese patients. Neither group showed significant change in weight and BMI. Clinical outcomes showed improvement in visual analog scale for back and leg pain with some improvement in Oswestry scores and were independent of the BMI of the patient. The incidence of postoperative complications was significant in 45% of morbidly obese and 44% of obese patients.
  
  
  CONCLUSIONS
  Obese and morbidly obese patients have multiple comorbidities, and the spinal surgeon should be prepared to encounter perioperative complexities. Operative times are longer in comparison with normal weight patients with a higher incidence of postoperative complications. No weight loss occurs after spinal surgery.
authors.affiliation: Department of Orthopedic Surgery, Detroit Receiving Hospital and University Health Center, Detroit, MI 48201, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Vaidya
authors.forename: Julia
authors.initials: J
authors.lastname: Carp
authors.forename: Stephen
authors.initials: S
authors.lastname: Bartol
authors.forename: Nicole
authors.initials: N
authors.lastname: Ouellette
authors.forename: Sandra
authors.initials: S
authors.lastname: Lee
authors.forename: Anil
authors.initials: A
authors.lastname: Sethi
mesh_terms: D001416:Back Pain / Q000453:epidemiology; D015992:Body Mass Index; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D009767:Obesity, Morbid / Q000453:epidemiology*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000453:epidemiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D015431:Weight Loss