Elevated Body Mass Index in Patients Undergoing Stand-alone Anterior and Lateral Lumbar Interbody Fusion: Complications, Hospital Length of Stay, and Cost.

IF 1.7 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2025-12-01 Epub Date: 2025-03-13 DOI:10.1097/BSD.0000000000001799

Ashley Knebel, Manjot Singh, Negin Fani, Andrew Ni, Michael Farias, Joseph E Nassar, Eren O Kuris, Bassel G Diebo, Alan H Daniels

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Abstract

Study design: Retrospective cohort study.

Objective: This study aims to evaluate the impact of body mass index (BMI) on postoperative outcomes following anterior, extreme lateral, and oblique lumbar interbody fusion (A/X/OLIF).

Background: Obesity is an increasingly common comorbidity among spine surgery patients, potentially leading to elevated postoperative complications. Little is known about the safety of A/X/OLIF approaches in overweight and obese patients.

Materials and methods: The PearlDiver database was queried to identify all adults who underwent single-level A/X/OLIF. Patients were stratified by BMI, defined as healthy weight (≤24.9 kg/m 2 ), overweight (25-29.9 kg/m 2 ), obese (30-39.9 kg/m 2 ), and morbidly obese (≥40 kg/m 2 ). Patient demographics and comorbidities were compared before matching, and complications were compared after matching for age, sex, and Charlson Comorbidity Index (CCI).

Results: Among the 36,716 A/X/OLIF included patients, 5464 (14.88%) were healthy weight, 9124 (24.85%) were overweight, 16,283 (44.35%) were obese, and 5845 (15.92%) were morbidly obese. The mean age was 54.4 years, 62.6% were females, and the mean CCI was 1.8. After matching, the mean age was 54.0 years, 70.1% were females, and the mean CCI was 1.4. At 90 days postoperatively, medical and surgical complication rates and readmission generally increased with increasing BMI (all P < 0.010). Length of stay (5.37, 5.51, 5.89, 6.69, P < 0.001) and 90-day costs ($19,326, $19,058, $19,680, $21,103, P = 0.002) also generally increased with increasing BMI. Intraoperative and 2-year complication rates were comparable across cohorts.

Conclusions: Elevated BMI was associated with increased 90-day postoperative complications but not increased intraoperative or 2-year complications following A/X/OLIF. Optimization for patients with higher BMI should be performed to improve perioperative outcomes, especially in the 90-day postoperative period, and ultimately the safety of these procedures for obese patients.

Level of evidence: Level III.

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接受独立前路和侧路腰椎椎体间融合术的患者体重指数升高：并发症、住院时间和费用。

研究设计：回顾性队列研究。目的：本研究旨在评估身体质量指数（BMI）对前路、极外侧和斜位腰椎椎体间融合（A/X/OLIF）术后预后的影响。背景：肥胖是脊柱手术患者中越来越常见的合并症，可能导致术后并发症的增加。对于A/X/OLIF方法在超重和肥胖患者中的安全性知之甚少。材料和方法：查询PearlDiver数据库以确定所有接受单级A/X/OLIF的成年人。根据BMI对患者进行分层，定义为健康体重（≤24.9 kg/m2）、超重（25-29.9 kg/m2）、肥胖（30-39.9 kg/m2）和病态肥胖（≥40 kg/m2）。配对前比较患者人口统计学和合并症，配对后比较年龄、性别和Charlson合并症指数（CCI）的并发症。结果：A/X/OLIF纳入的36716例患者中，健康体重5464例（14.88%），超重9124例（24.85%），肥胖16283例（44.35%），病态肥胖5845例（15.92%）。平均年龄54.4岁，女性占62.6%，平均CCI为1.8。经配对后，平均年龄为54.0岁，女性占70.1%，平均CCI为1.4。术后90天，内科和外科并发症发生率及再入院率普遍随BMI升高而升高（P < 0.010）。住院时间（5.37、5.51、5.89、6.69,P < 0.001）和90天住院费用（19,326美元、19,058美元、19,680美元、21,103美元，P = 0.002）也普遍随着BMI的增加而增加。术中和2年并发症发生率在各队列间具有可比性。结论：BMI升高与A/X/OLIF术后90天并发症的增加有关，但与术中或术后2年并发症的增加无关。应该对BMI较高的患者进行优化，以改善围手术期，特别是术后90天的预后，并最终提高肥胖患者手术的安全性。证据等级：三级。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.