title: Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery.
abstract: OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement overtime, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.
authors.affiliation: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Alex
authors.initials: A
authors.lastname: Soroceanu
authors.affiliation: Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Bassel Georges
authors.initials: BG
authors.lastname: Diebo
authors.affiliation: Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Mundis
authors.affiliation: Orthopaedic Surgery, University of California San Francisco, California.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.affiliation: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
authors.affiliation: Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Orthopaedic Surgery, University of California Davis, Sacramento, California; and.
authors.forename: Munish C
authors.initials: MC
authors.lastname: Gupta
authors.affiliation: Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
keywords: ASD = adult spinal deformity; BMI = body mass index; CCI = Charlson Comorbidity Index; EBL = estimated blood loss; HRQL = health-related quality of life; IBF = interbody fusion; IRR = incidence rate ratio; LOS = length of stay; ODI = Oswestry Disability Index; OR = operating room; SF = Short Form; SRS = Scoliosis Research Society; adult spinal deformity; complications; deformity; obesity; outcomes