title: Impact of body habitus on perioperative morbidity associated with fusion of the thoracolumbar and lumbar spine.
abstract: OBJECTIVE
  Spinal fusion is performed in patients ranging from young and healthy to aged and frail. Although recent population trends in the United States are toward obesity, no large-scale study has evaluated how body habitus affects mortality, complications, and resource utilization for lumbar spine fusion. Such information is important for patient selection and to confirm the safety of such procedures in this population.
  
  
  METHODS
  Data for 244 170 patients who underwent thoracolumbar or lumbar spine fusion for degenerative disease between 1988 and 2004 were collected from the Nationwide Inpatient Sample database, and subjects were grouped by surgical approach and body habitus. Multivariate logistic regression evaluated group effects on selected postoperative complications, length of stay, resource utilization, and discharge disposition.
  
  
  RESULTS
  This study confirms that body habitus affects perioperative morbidity sustained by patients undergoing thoracolumbar or lumbar spine fusion. Demographic heterogeneity exists for race, geography, and number of diseased levels among body habitus groups, prompting application of multivariate logistic regression for outcomes. For all approaches, higher body mass index associated with increased transfusion requirements and likelihood of discharge to assisted living. Furthermore, morbidly obese patients undergoing posterior fusion sustained more wound complications and postoperative infections.
  
  
  CONCLUSIONS
  This nationwide study describes inpatient complications encountered during fusion surgery in patients who are obese. For a given surgical approach, patients with higher body mass index sustain increased transfusion requirements and utilize more resources during thoracolumbar and lumbar spine fusion. Nevertheless, the findings of equivalent mortality, length of stay, and other complication rates suggest that patients who are obese remain safe surgical candidates.
authors.affiliation: Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada. mohammed.shamji@duke.edu
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Shamji
authors.forename: Stephen
authors.initials: S
authors.lastname: Parker
authors.forename: Chad
authors.initials: C
authors.lastname: Cook
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Christopher
authors.initials: C
authors.lastname: Brown
authors.forename: Robert E
authors.initials: RE
authors.lastname: Isaacs
mesh_terms: D000328:Adult; D015897:Comorbidity; D016206:Databases, Bibliographic / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007432:Intraoperative Period / Q000401:mortality*; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D009767:Obesity, Morbid / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000453:epidemiology / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods