title: Obesity negatively affects spinal surgery in idiopathic scoliosis.
abstract: BACKGROUND
  Are obese patients with idiopathic scoliosis undergoing spinal surgery at higher risk for perioperative complications? This is not clearly understood. One previous study showed a greater preoperative thoracic kyphosis but no increase in perioperative complications.
  
  
  OBJECTIVE
  We asked whether obese adolescents with idiopathic scoliosis have more perioperative complications and decreased curve correction.
  
  
  METHODS
  We retrospectively reviewed 478 patients with idiopathic scoliosis operated on from 1998 to 2010. There were 236 (187 females, 49 males) with a mean age of 14 years (range, 11-22 years) who met the inclusion criteria. Demographic data, radiographic measurements, perioperative data, and major and minor complications were recorded. The BMI percentile (BMI%) defined two patient groups: healthy weight (BMI%<85) (n=181) and obese (BMI%≥85) (n=55). The preoperative curves were similar in the two groups. Minimum followup was 2 years (mean, 6 years; range, 2-14 years).
  
  
  RESULTS
  Postoperatively, the mean major curve was smaller for healthy-weight patients (20°; range, 8°-36°) than for obese patients (23.2°; range, 12°-56°), as was the mean kyphosis (31.1° [range, 10°-56°]) versus 36° [range, 15°-33°], respectively). The postoperative lordosis was similar in both groups. Increased BMI% correlated with increased operative time, intraoperative blood loss, amount of intraoperative crystalloids, and difficulty with administration of spinal anesthesia.
  
  
  CONCLUSIONS
  Obese patients are at higher risk for perioperative complications when undergoing spinal deformity surgery. Counseling should be done with the patient and family and weight loss recommended before surgery.
  
  
  METHODS
  Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
authors.forename: Christina K
authors.initials: CK
authors.lastname: Hardesty
authors.forename: Connie
authors.initials: C
authors.lastname: Poe-Kochert
authors.forename: Jochen P
authors.initials: JP
authors.lastname: Son-Hing
authors.forename: George H
authors.initials: GH
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult