Anterior and posterior cervical fusion in patients with high body mass index are not associated with greater complications
Anterior and posterior cervical fusion in patients with high body mass index are not associated with greater complications
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DOI：
10.1016/j.spinee.2013.09.054
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发表时间：
2014-08-01
期刊：
影响因子：
4.5
通讯作者：
Grauer, Jonathan N.
中科院分区：
文献类型：
--
作者：
Buerba, Rafael A.;Fu, Michael C.;Grauer, Jonathan N.
背景情况：肥胖与不良手术结果有关;然而，关于肥胖对颈椎融合结果影响的信息有限。目的：确定肥胖对颈椎融合术后并发症发生率的影响。研究设计/设置：对前瞻性收集的颈椎融合手术数据进行回顾性队列分析。ACS-NSQIP数据库中2005年至2010年接受颈椎前路或后路融合术的患者。主要结局指标为术后30天并发症，包括死亡率、深静脉血栓形成、肺栓塞、脓毒性并发症、系统特异性并发症，并且总体上具有>= 1个并发症。次要结果是在手术室花费的时间，输血，住院时间，并在30 days.METHODS内再次手术：在2005-2010年美国外科医师学会国家外科手术质量改进计划中接受颈椎前路或后路融合的患者使用当前程序术语代码进行选择。颈椎前路融合患者根据体重指数（BMI）分为4组：非肥胖（18.5-29.9 kg/m2）、肥胖I（30-34.9 kg/m2）、肥胖II（35-39.9 kg/m2）和肥胖III（≥ 40 kg/m2）。颈椎后路患者根据BMI分为两组：非肥胖（18.5-29.9 kg/m2）和肥胖（>= 30 kg/m2），因为样本量较小。通过卡方检验、Fisher精确检验、Student t检验和方差分析比较肥胖组和非肥胖组的患者。使用多变量线性/逻辑回归模型校正术前合并症。作者没有报道与本研究相关的资金来源或利益冲突。结果：分别有3,671和400例接受颈椎前路或后路融合术的患者的数据。单变量分析显示，肥胖III级患者前路融合术后深静脉血栓形成的发生率更高。单变量分析显示，肥胖患者后路融合后的平均手术时间和总手术室时间较长。在多变量分析中，这些差异并不显著。在多变量分析中，与非肥胖组颈椎前路或后路融合相比，肥胖组的总体和系统特异性并发症发生率、住院时间、再手术率和死亡率也没有差异。结论：高BMI，无论肥胖类型如何，似乎与术后30天颈椎融合后并发症增加无关。(C)2014爱思唯尔公司All rights reserved.
BACKGROUND CONTEXT: Obesity has been associated with adverse surgical outcomes; however, limited information is available regarding the effect of obesity on cervical spinal fusion outcomes.PURPOSE: To determine the effect of obesity on complication rates after cervical fusions.STUDY DESIGN/SETTING: Retrospective cohort analysis of prospectively collected data on cervical fusion surgeries.PATIENT SAMPLE: Patients in the ACS-NSQIP database from 2005 to 2010 undergoing cervical anterior or posterior fusion.OUTCOME MEASURES: Primary outcome measures were 30-day postsurgical complications, including mortality, deep-vein thrombosis, pulmonary embolism, septic complications, system-specific complications, and having >= 1 complication overall. Secondary outcomes were time spent in the operating room, blood transfusions, length of stay, and reoperation within 30 days.METHODS: Patients undergoing anterior or posterior cervical fusions in the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program were selected using Current Procedural Terminology codes. Anterior cervical fusion patients were categorized into four groups on the basis of body mass index (BMI): nonobese (18.5-29.9 kg/m(2)), obese I (30-34.9 kg/m(2)), obese II (35-39.9 kg/m(2)), and obese III (>= 40 kg/m(2)). Posterior cervical patients were categorized into two groups based on the basis of BMI: nonobese (18.5-29.9 kg/m(2)) and obese (>= 30 kg/m(2)) due to the smaller sample size. Patients in the obese categories were compared with patients in the nonobese categories by the use of chi(2), Fisher's exact test, Student t test, and analysis of variance. Multivariate linear/logistic regression models were used to adjust for preoperative comorbidities. The authors report no sources of funding or conflicts of interest related to this study.RESULTS: Data were available for 3,671 and 400 patients who underwent anterior or posterior cervical fusion, respectively. Obese class III patients only showed a greater incidence of deep-vein thrombosis after anterior fusions on univariate analysis. Obese patients only showed longer mean surgical times and total operating room times after posterior fusions on univariate analysis. On multivariate analyses, these differences did not remain significant. There were also no differences in multivariate analyses for overall and system-specific complication rates, lengths of hospital stay, reoperation rates, and mortality among the obesity groups when compared with the nonobese groups with anterior or posterior cervical fusions.CONCLUSIONS: High BMI, regardless of obesity class, does not appear to be associated with increased complications after cervical fusion in the 30-day postoperative period. (C) 2014 Elsevier Inc. All rights reserved.