title: Perioperative outcomes of anterior lumbar surgery in obese versus non-obese patients.
abstract: BACKGROUND
  Anterior lumbar surgery is a common procedure for anterior lumbar interbody fusion and disc replacement but the impact of obesity on this procedure has not been determined.
  
  
  OBJECTIVE
  To assess the perioperative outcomes of anterior retroperitoneal lumbar surgery in obese versus non-obese patients.
  
  
  METHODS
  Prospective review of patients with anterior retroperitoneal lumbar disc procedures
  
  
  METHODS
  Seventy-four patients with anterior retroperitoneal lumbar disc procedures performed were evaluated.
  
  
  METHODS
  Access-related parameters included tissue depth (skin-to-fascia and fascia-to-spine depths), length of incision, estimated blood loss during the anterior procedure, the duration of the anterior exposure, and the duration of the entire anterior procedure. Outcome measures included complications attributable to the anterior procedure, analgesic use, length of time to ambulation, and length of hospitalization.
  
  
  METHODS
  Seventy-four anterior retroperitoneal lumbar disc procedures were prospectively analyzed. Patient age, sex, body mass index, comorbidities, diagnosis, and operative parameters were collected. Access-related parameters and outcome measures were compared between obese and non-obese patients. Obesity was defined as body mass index greater than or equal to 30.
  
  
  RESULTS
  There were 35 males and 39 females. Mean age was 46.6 years. The main diagnosis (63.5%) was discogenic back pain. Forty-one (55%) patients were non-obese and 33 were obese. The two patient groups were comparable in terms of age, sex, diagnosis, mean number of anterior levels operated, and previous abdominal surgery (all p>.05). In obese patients, there were two iliac vein lacerations (major complication rate, 6.1%), one superficial infection, and one urinary tract infection (minor complication rate, 6.1%). In non-obese patients, there were two iliac vein lacerations, one intestinal serosal tear (major complication rate, 7.3%), and two urinary tract infections (minor complication rate, 4.9%). There was no significant difference in the complication rates between obese and non-obese patients (p=.6). Obese patients have significantly longer duration of anterior exposure, duration of entire anterior surgery, longer length of anterior incision, and more depth from skin to fascia and from fascia to spine compared with non-obese patients. However, obesity does not affect blood loss, analgesic use, length of time to ambulation, and length of hospitalization.
  
  
  CONCLUSIONS
  Perioperative outcomes in obese and non-obese patients were comparable and obesity is not related to an increased risk of morbidity in anterior lumbar surgery.
authors.affiliation: NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. bencwpeng@gmail.com
authors.forename: Chan W B
authors.initials: CW
authors.lastname: Peng
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Goldstein
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Nalbandian
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000601:surgery; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D011183:Postoperative Complications; D020127:Recovery of Function; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000706:statistics & numerical data; D013995:Time; D016896:Treatment Outcome