Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: B. Mayo

Author(s):

B. Haws(1), B. Khechen(1), A. Narain(1), F. Hijji(1), K. Cardinal(1), J. Guntin(1), B. Mayo(1), J. Markowitz(1), K. Singh(1)

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

Abstract

Introduction: With the increasing prevalence of obesity, more patients with high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes after anterior cervical discectomy and fusion (ACDF) procedures. As such, the purpose of this study is to compare surgical outcomes, postoperative narcotics consumption, complications, and costs among BMI stratifications for patients undergoing primary 1-2 level ACDF.

Methods: Patients that underwent primary, 1-2 level ACDF were reviewed. Patients were stratified by BMI as follows: normal weight (< 25.0kg/m2), overweight (25.0-29.9 kg/m2), obese I (30.0-34.9 kg/m2), or obese II-III (≥35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using one-way analysis of variance or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in VAS pain scores, incidence of complications, arthrodesis rates, reoperation rates, and costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.

Results: A total of 277 patients were included in the analysis, of which 20.9% (58) were normal weight, 37.5% (104) were overweight, 24.9% (69) were obese I, and 16.6% (46) were obese II-III. Higher BMI was associated with older age (p=0.049) and increased comorbidity burden (p=0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative Visual Analogue Scale (VAS) pain scores were found between cohorts (p>0.05). No significant differences were found between BMI cohorts in regards to operative time, intraoperative blood loss, length of hospital stay, or number of operative levels (p>0.05). Additionally, no significant differences existed across BMI stratifications in postoperative narcotics consumption, VAS pain score improvement, complication rate, arthrodesis rate, reoperation rate, or total direct costs (p>0.05).

Conclusions: Patients with higher BMI demonstrated comparable surgical outcomes, narcotics consumption, and hospital costs compared to those with lower BMI. As such, ACDF procedures are both safe and effective for patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI status.

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