Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness

Olivia J. Bono, Gregory W. Poorman, Norah Foster, Cyrus M. Jalai, Samantha R. Horn, Jonathan Oren, Alexandra Soroceanu, Subaraman Ramachandran, Taylor E. Purvis, Deeptee Jain, Shaleen Vira, Bassel G. Diebo, Breton Line, Daniel Sciubba, Themistocles S. Protopsaltis, Aaron J. Buckland, Thomas J. Errico, Virginie Lafage, Shay Bess, Peter G. Passias

Research output: Contribution to journalArticle

Abstract

Background Context: Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood. Purpose: Identify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery. Study Design/Setting: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013. Patient Sample: A total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine. Outcome Measures: Complication rates. Methods: The patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries. Results: Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (odds ratio [OR] [95% confidence interval (CI)]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05). Conclusion: There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.

Original languageEnglish (US)
JournalSpine Journal
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Spine
Body Mass Index
Obesity
Comorbidity
Odds Ratio
Diskectomy
Laminectomy
Thinness
Arthrodesis
Osteotomy
Quality Improvement
Infection
Analysis of Variance
Logistic Models
Smoking
Outcome Assessment (Health Care)
Confidence Intervals
Pathology
Hypertension

Keywords

  • Complications
  • Lumbar
  • Obesity
  • Predictor
  • Risk
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bono, O. J., Poorman, G. W., Foster, N., Jalai, C. M., Horn, S. R., Oren, J., ... Passias, P. G. (Accepted/In press). Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. Spine Journal. https://doi.org/10.1016/j.spinee.2017.11.015

Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. / Bono, Olivia J.; Poorman, Gregory W.; Foster, Norah; Jalai, Cyrus M.; Horn, Samantha R.; Oren, Jonathan; Soroceanu, Alexandra; Ramachandran, Subaraman; Purvis, Taylor E.; Jain, Deeptee; Vira, Shaleen; Diebo, Bassel G.; Line, Breton; Sciubba, Daniel; Protopsaltis, Themistocles S.; Buckland, Aaron J.; Errico, Thomas J.; Lafage, Virginie; Bess, Shay; Passias, Peter G.

In: Spine Journal, 01.01.2018.

Research output: Contribution to journalArticle

Bono, OJ, Poorman, GW, Foster, N, Jalai, CM, Horn, SR, Oren, J, Soroceanu, A, Ramachandran, S, Purvis, TE, Jain, D, Vira, S, Diebo, BG, Line, B, Sciubba, D, Protopsaltis, TS, Buckland, AJ, Errico, TJ, Lafage, V, Bess, S & Passias, PG 2018, 'Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness', Spine Journal. https://doi.org/10.1016/j.spinee.2017.11.015
Bono, Olivia J. ; Poorman, Gregory W. ; Foster, Norah ; Jalai, Cyrus M. ; Horn, Samantha R. ; Oren, Jonathan ; Soroceanu, Alexandra ; Ramachandran, Subaraman ; Purvis, Taylor E. ; Jain, Deeptee ; Vira, Shaleen ; Diebo, Bassel G. ; Line, Breton ; Sciubba, Daniel ; Protopsaltis, Themistocles S. ; Buckland, Aaron J. ; Errico, Thomas J. ; Lafage, Virginie ; Bess, Shay ; Passias, Peter G. / Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. In: Spine Journal. 2018.
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title = "Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness",
abstract = "Background Context: Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood. Purpose: Identify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery. Study Design/Setting: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013. Patient Sample: A total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine. Outcome Measures: Complication rates. Methods: The patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries. Results: Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (odds ratio [OR] [95{\%} confidence interval (CI)]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05). Conclusion: There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.",
keywords = "Complications, Lumbar, Obesity, Predictor, Risk, Spine",
author = "Bono, {Olivia J.} and Poorman, {Gregory W.} and Norah Foster and Jalai, {Cyrus M.} and Horn, {Samantha R.} and Jonathan Oren and Alexandra Soroceanu and Subaraman Ramachandran and Purvis, {Taylor E.} and Deeptee Jain and Shaleen Vira and Diebo, {Bassel G.} and Breton Line and Daniel Sciubba and Protopsaltis, {Themistocles S.} and Buckland, {Aaron J.} and Errico, {Thomas J.} and Virginie Lafage and Shay Bess and Passias, {Peter G.}",
year = "2018",
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T1 - Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness

AU - Bono, Olivia J.

AU - Poorman, Gregory W.

AU - Foster, Norah

AU - Jalai, Cyrus M.

AU - Horn, Samantha R.

AU - Oren, Jonathan

AU - Soroceanu, Alexandra

AU - Ramachandran, Subaraman

AU - Purvis, Taylor E.

AU - Jain, Deeptee

AU - Vira, Shaleen

AU - Diebo, Bassel G.

AU - Line, Breton

AU - Sciubba, Daniel

AU - Protopsaltis, Themistocles S.

AU - Buckland, Aaron J.

AU - Errico, Thomas J.

AU - Lafage, Virginie

AU - Bess, Shay

AU - Passias, Peter G.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background Context: Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood. Purpose: Identify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery. Study Design/Setting: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013. Patient Sample: A total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine. Outcome Measures: Complication rates. Methods: The patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries. Results: Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (odds ratio [OR] [95% confidence interval (CI)]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05). Conclusion: There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.

AB - Background Context: Obesity as a comorbidity in spine pathology may increase the risk of complications following surgical treatment. The body mass index (BMI) threshold at which obesity becomes clinically relevant, and the exact nature of that effect, remains poorly understood. Purpose: Identify the BMI that independently predicts risk of postoperative complications following lumbar spine surgery. Study Design/Setting: Retrospective review of the National Surgery Quality Improvement Program (NSQIP) years 2011-2013. Patient Sample: A total of 31,763 patients were undergoing arthrodesis, discectomy, laminectomy, laminoplasty, corpectomy, or osteotomy of the lumbar spine. Outcome Measures: Complication rates. Methods: The patient sample was categorized preoperatively by BMI according to the World Health Organization stratification: underweight (BMI <18.5), normal overweight (BMI 20.0-29.9), obesity class 1 (BMI 30.0-34.9), 2 (BMI 35.0-39.9), and 3 (BMI≥40). Patients were dichotomized based on their position above or below the 75th surgical invasiveness index (SII) percentile cutoff into low-SII and high-SII. Differences in complication rates in BMI groups were analyzed by Bonferroni analysis of variance (ANOVA) method. Multivariate binary logistic regression evaluated relationship between BMI and complication categories in all patients and in high-SII and low-SII surgeries. Results: Controlling for baseline difference in SII, Charlson Comorbidity Index (CCI) score, diabetes, hypertension, and smoking, complications significantly increased at a BMI of 35 kg/m2. The odds ratios for any complication (odds ratio [OR] [95% confidence interval (CI)]; obesity 2: 1.218 [1.020-1.455]; obesity 3: 1.742 [1.439-2.110]), infection (obesity 2: 1.335 [1.110-1.605]; obesity 3: 1.685 [1.372-2.069]), and surgical complication (obesity 2: 1.622 [1.250-2.104]; obesity 3: 2.798 [2.154-3.634]) were significantly higher in obesity classes 2 and 3 relative to the normal-overweight cohort (all p<.05). Conclusion: There is a significant increase in complications, specifically infection and surgical complications, in patients with BMI≥35 following lumbar spine surgery, with that rate further increasing with BMI≥40.

KW - Complications

KW - Lumbar

KW - Obesity

KW - Predictor

KW - Risk

KW - Spine

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