title: Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery.
abstract: METHODS
  Retrospective database analysis.
  
  
  OBJECTIVE
  To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery.
  
  
  BACKGROUND
  There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed.
  
  
  METHODS
  A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ test was used to assess for statistical significance.
  
  
  RESULTS
  The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures.
  
  
  CONCLUSIONS
  This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Burks
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.forename: Scott
authors.initials: S
authors.lastname: Yang
authors.forename: Adam L
authors.initials: AL
authors.lastname: Shimer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015331:Cohort Studies; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications*; D019637:Orthopedic Procedures / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects; D013131:Spine / Q000601:surgery*