The Impact of Obesity on Risk Factors for Adverse Outcomes in Patients Undergoing Elective Posterior Lumbar Spine Fusion

Deeptee Jain, MD; Wesley Durand, BS; Jeremy D. Shaw, MD; Shane Burch, MD; Vedat Deviren, MD; Sigurd Berven, MD

Disclosures

Spine. 2021;46(7):457-463. 

In This Article

Results

After applying inclusion and exclusion criteria, we analyzed 292,339 patients. After excluding patients with missing data, there were 262,153. Baseline demographics and comorbidities are presented in Table 1. There were 31,062 obese patients and 231,091 nonobese patients. Obese patients had significantly higher rates of all outcome variables that non-obese patients: 90-day major medical complications (7.0 vs. 4.3%, P < 0.001), infection (4.6 vs. 2.3%, P < 0.001), readmission (15.6 vs. 12.2%, P < 0.001), and revision (4.7 vs. 3.2%, P < 0.001). Results of the multivariable regression in the entire cohort for all outcome variables are shown in Table S3, http://links.lww.com/BRS/B673.

Interactions between obesity and other independent variables were tested, generating P values for the interaction, depicted as a heat-map in Table 2 (see Table S4 for numeric values, http://links.lww.com/BRS/B674).

For major complications, obese patients exhibited lower odds ratios than nonobese patients for cerebrovascular disease (P < 0.0001), diabetes with chronic complications (P < 0.0001), age ≥65 (P < 0.0001), congestive heart failure (P = 0.0007), history of myocardial infarction (MI) (P = 0.0004), renal disease (P = 0.0073), chronic pulmonary disease (P < 0.0001), Medicare/Medicaid payor (P < 0.0001), more than two levels fused (P = 0.0107), transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) (P = 0.0038), and female sex (P = 0.0089). Obese patients exhibited a higher odds ratio for major complications for non-White race (P = 0.0006). (Figure 1).

Figure 1.

Odds ratios of risk factors in obese vs. nonobese patients on 90-day major complications. Only significantly different odds ratios are depicted.

For readmission, obese patients exhibited lower odds ratios than nonobese patients for age ≥65 (P = 0.0034), history of MI (P = 0.0073), renal disease (P = 0.0060), and mental health disease (P = 0.0091), while demonstrating a higher odds ratio for female sex (P = 0.0004) (Figure 2).

Figure 2.

Odds ratios of risk factors in obese vs. nonobese patients on 90-day readmission. Only significantly different odds ratios are depicted.

For revision, obese patients exhibited higher odds ratios for female sex (P = 0.0033) and TLIF or PLIF (P = 0.0019) (Figure 3).

Figure 3.

Odds ratios of risk factors in obese vs. nonobese patients on 90-day revision. Only significantly different odds ratios are depicted.

For infection, obese patients demonstrated lower odds ratios for diabetes, both with chronic complications (P = 0.0006) and without (P = 0.0086), while exhibiting higher odds ratios for female gender (P < 0.0001) (Figure 4).

Figure 4.

Odds ratios of risk factors in obese vs. nonobese patients on 90-day infection. Only significantly different odds ratios are depicted.

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