422 - Impact of Body Mass Index on Complication Rates in Cervical Spine Surg...

#422 Impact of Body Mass Index on Complication Rates in Cervical Spine Surgery

Cervical Therapies and Outcomes

Poster Presented by: K. Singh

Author(s):

S.V. Nandyala (1)
A.J. Marquez-Lara (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Increasing body mass index has been demonstrated to increase post-operative complication rates in several surgical procedures. These complications can be devastating, particularly in the setting of elective surgery. Using a national surgical database, we attempted to characterize the impact of body mass index (BMI) on the rate of complications following cervical spine surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database was utilized to identify patients undergoing elective cervical spine surgery for degenerative diagnoses between 2006 and 2011. Surgical procedures included anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) procedures. Patients with trauma, infection, tumor, and deformity diagnoses were excluded. Patients were divided into groups based upon their BMI (Normal: 18.5-24.9 kg/m2, Overweight: 25-29.9 kg/m2, Class I: 30-34.9 kg/m2, Class II: 35-35.9 kg/m2, Class III: greater than 40). Pre-operative health and co-morbidity data including laboratory values, as well as operative time, blood transfusions, and 30 day outcomes including length of stay (LOS), re-admission rate, re-operation rate, and complication rates were analyzed. Statistical analysis was performed with SPSS v.20 using Pearson´s rank correlations to assess correlations between variables and increasing levels of obesity. P-values ≤ 0.05 were considered statistically significant.

Results: A total of 8,496 cervical spine surgeries were identified from 2006-2011, with 1,908 normal (22.5%), 2,943 overweight (34.6%), 2,140 class I (25.2%), 934 class II (11.0%), and 571 class III (6.7%) BMI patients. Increasing rates of diabetes, hypertension correlated with increasing obesity (p < 0.001). Increasing BMI class also correlated with increasing WBC and platelet count, and decreasing hematocrit and serum albumin (p < 0.0001). Operative time increased along with obesity class as well (p< 0.0001, R = 0.04). Overall postoperative complications were more common amongst heavier patients (p = 0.013; R = 0.03) particularly superficial wound infection (p = 0.044; R = 0.03).

Conclusion: Our study utilizes the National Surgical Quality Improvement Program to examine the complication rates with increasing BMI following cervical spine surgery. We demonstrated that patients with increasing BMI have increasing prevalence of certain co-morbidities, experience longer operative times, and an increasing risk of overall complications, particularly superficial infections. Development of pre-operative protocols based upon these findings may help decrease the morbidity, length of stay and hospital costs associated with cervical wound complications.