title: Impact of increased body mass index on outcomes of elective spinal surgery.
abstract: METHODS
  Observational retrospective cohort study of prospectively collected database.
  
  
  OBJECTIVE
  To determine whether overweight body mass index (BMI) influences 30-day outcomes of elective spine surgery.
  
  
  BACKGROUND
  Obesity is prevalent in the United States, but its impact on the outcome of elective spine surgery remains controversial.
  
  
  METHODS
  We used National Surgical Quality Improvement Program, a prospective clinical database with proven validity and reproducibility consisting of 256 perioperative standardized variables from surgical patients at nearly 400 academic and nonacademic hospitals nationwide. We identified 49,314 patients who underwent elective fusion, laminectomy or both between 2006 and 2012. We divided patients according to BMI (kg/m2) as normal (18.5-24.9), preobese (25.0-29.9), obese I (30.0-34.9), obese II (35.0-39.9), and obese III (≥40). Relationship between increased BMI and outcome of surgery measured as prolonged hospitalization, complications, return to the operating room, discharged with continued care requirement, readmission, and death was determined using logistic regression before and after propensity score matching.
  
  
  RESULTS
  All overweight patients (BMI ≥25 kg/m2) showed increased odds of an adverse outcome compared with normal patients in unmatched analyses, with maximal effect seen in obese III group. In the propensity-matched sample, obese III patients continued to show increased odds for complications (odds ratio, 1.6; 95% confidence interval, 1.1-2.3), readmission (odds ratio, 2.3; 95% confidence interval, 1.1-4.9), and return to the operating room (odds ratio, 1.8; 95% confidence interval, 1.1-3.1).
  
  
  CONCLUSIONS
  Impact of obesity on elective spine surgery outcome is mediated, at least in part, by comorbidities in patients with BMI between 25.0 and 39.9 kg/m2. However, BMI itself is an independent risk factor for adverse outcomes in morbidly obese patients.
  
  
  METHODS
  3.
authors.affiliation: *Case Western Reserve University School of Medicine, Cleveland, OH †Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH ‡Departments of Pulmonary Critical Care and Sleep Medicine, University Hospitals, Cleveland, OH §Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH ¶Medical University of Warsaw, Warsaw, Poland ‖Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, OH **The Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH; and ††Department of Neurosurgery, Geisinger Health System, Danville, PA.
authors.forename: Andreea
authors.initials: A
authors.lastname: Seicean
authors.forename: Nima
authors.initials: N
authors.lastname: Alan
authors.forename: Sinziana
authors.initials: S
authors.lastname: Seicean
authors.forename: Marta
authors.initials: M
authors.lastname: Worwag
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016208:Databases, Factual / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013131:Spine / Q000601:surgery*; D014481:United States