Lumbar fusion deemed safe for obese patients

MIAMI — Patients who are obese may require more blood transfusions and assistance at discharge after lumbar fusion compared to nonobese patients, but they are still considered candidates for the procedure, according to a study presented here.

Researchers from Duke University Medical Center obtained data on 244,170 patients undergoing lumbar spine fusion between 1988 and 2004 using the Nationwide Inpatient Sample database. Patients were grouped by surgical approach (ie, anterior, lateral and posterior) and body habitus or type (normal, obese or morbidly obese).

The investigators also measured multivariate logistic regression testing group effects on the incidence of postoperative complications, duration of hospitalization, resource utilization and discharge disposition, Stephen Parker, MD, said at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine.

Although several smaller studies have suggested that obesity is a predictor of perioperative complications, “This is the first large-scale study to determine the effect of body habitus on the perioperative course of these patients in terms of mortality, complication rates and resource utilization in lumbar fusion,” he said.

Parker said obese and morbidly obese patients were more likely to live in an assisted living facility and their hospital costs were often greater. However, their length of hospital stay was not necessarily longer than that of nonobese patients.

“Although obese patients are more likely to need additional transfusions, we can take that into consideration and perhaps [reconsider] using autologous blood replacement” when operating on obese or morbidly obese patients, he said.

In addition, “Morbidly obese patients undergoing posterior surgery sustained more frequent wound complications and postoperative infections, but all of the body [type] groups had comparable morbidity, length of stay and other perioperative complication rates,” Parker said.

Obese patients did have a slightly higher incidence of cauda equina problems, although the researchers could not pinpoint the reason why, he said.

Reference:
Shamji MF, Parker S, Cook C, et al. How does body habitus affect the perioperative morbidity of patients undergoing lumbar spine fusion? Paper #1. Presented at the 36th Annual Meeting of the International Society for the Study of the Lumbar Spine. May 4-8, 2009. Miami.