title: Obesity and spine surgery: reassessment based on a prospective evaluation of perioperative complications in elective degenerative thoracolumbar procedures.
abstract: BACKGROUND
  The correlation between obesity and incidence of complications in spine surgery is unclear, with some reports suggesting linear relationships between body mass index (BMI) and complication incidence and others noting no relationship.
  
  
  OBJECTIVE
  The purpose of this article was to assess the relationship between obesity and occurrence of perioperative complications in an elective thoracolumbar surgery cohort.
  
  
  METHODS
  Prospective observational cohort study at a tertiary care facility.
  
  
  METHODS
  Cohort of 87 consecutive patients undergoing elective surgery for degenerative thoracolumbar pathologies over a 6-month period (May to December 2008).
  
  
  METHODS
  Incidence of perioperative complications (those occurring within 30 days of surgery).
  
  
  METHODS
  A prospective assessment of perioperative spine surgery complications was completed, and data were prospectively entered into a central database. Two independent auditors assessed for the presence and severity of perioperative complications. Previously validated binary definitions of major and minor complications were used. Patient data and early complications (those occurring within 30 days of index surgery) were analyzed using multivariate regression.
  
  
  RESULTS
  Mean BMI in this cohort was 31.3; 40.8% of patients were obese (BMI>30) and 10 patients (11.5%) were morbidly obese (BMI>40). The overall complication incidence was 67%. Minor complications occurred in 50% of patients, and major complications occurred in 17.8% of patients. No positioning palsies occurred in this series. Age correlated with an increase in complication risk (p=.006) as did hypertension (p=.004) and performance of a fusion (p<.0001). BMI did not correlate with the incidence of minor, major, or any complications (p=.58).
  
  
  CONCLUSIONS
  This prospective assessment of perioperative complications in elective degenerative thoracolumbar procedures shows no relationship between patient BMI and the incidence of perioperative minor or major complications. Specific care in perioperative positioning may limit the risk of perioperative positioning palsies in obese patients.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University Medical Center, Philadelphia, PA 19107, USA.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Yadla
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malone
authors.forename: Peter G
authors.initials: PG
authors.lastname: Campbell
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Ashwini D
authors.initials: AD
authors.lastname: Sharan
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
mesh_terms: D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects; D013904:Thoracic Vertebrae / Q000601:surgery*