Minimally invasive posterior lumbar surgery in the morbidly obese, obese and non-obese populations: A single institution retrospective review

Esteban Molina; David Zhao; Ehsan Dowlati; Austin H Carroll; Kyle B Mueller; Faheem A Sandhu; Jean-Marc Voyadzis

doi:10.1016/j.clineuro.2021.106746

Minimally invasive posterior lumbar surgery in the morbidly obese, obese and non-obese populations: A single institution retrospective review

Clin Neurol Neurosurg. 2021 Aug:207:106746. doi: 10.1016/j.clineuro.2021.106746. Epub 2021 Jun 8.

Authors

Esteban Molina¹, David Zhao², Ehsan Dowlati³, Austin H Carroll¹, Kyle B Mueller², Faheem A Sandhu², Jean-Marc Voyadzis⁴

Affiliations

¹ Georgetown University School of Medicine, Washington, DC, USA.
² Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA.
³ Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: edowlati@gmail.com.
⁴ Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA. Electronic address: jmvoyadzis@gmail.com.

PMID: 34144463
DOI: 10.1016/j.clineuro.2021.106746

Abstract

Background: There is a paucity of information regarding outcomes in minimally invasive surgical (MIS) approaches to posterior lumbar surgery in morbidly obese patients. We seek to determine if there are differences in operative variables and early complication rates in morbidly obese patients undergoing MIS posterior lumbar surgery compared to obese and non-obese patients.

Methods: A single institution retrospective review of patients undergoing MIS posterior lumbar surgery (decompression and/or fusion) between 2013 and 2016 was performed. Morbidly obese patients (BMI ≥ 40) were compared to obese (BMI 30-39.9) and non-obese (BMI < 30) cohorts. Postoperative complication rates and perioperative variables including estimated blood loss, operative time, and outcome measures including length of stay (LOS), in-hospital complications, readmission, and disposition were assessed.

Results: 47 morbidly obese, 135 obese and 224 non-obese patients underwent posterior MIS instrumented fusion. 59 morbidly obese, 182 obese and 314 non-obese patients underwent posterior MIS decompression. The morbidly obese group experienced a greater rate of deep vein thrombosis and had an increased hospital LOS (p < 0.05). Morbidly obese patients who underwent MIS decompression experienced increased postoperative complications (p < 0.01), and increased LOS (p < 0.0001) compared to obese and non-obese patients. There were no differences in revision rates, readmissions, and other complications including surgical site infection. Morbid obesity was an independent predictor of overall complications and increased LOS on multivariate analysis.

Conclusion: Morbidly obese patients undergoing posterior MIS fusion had a higher rate of complications and increased LOS. While weight loss should be encouraged, complication rates remains acceptably low in morbidly obese patients and MIS posterior lumbar surgery should still be offered.

Keywords: Fusion; Lumbar; Minimally invasive; Morbid obesity; Spinal surgery.

MeSH terms

Adult
Aged
Decompression, Surgical / methods
Female
Humans
Length of Stay
Lumbar Vertebrae / surgery
Male
Middle Aged
Minimally Invasive Surgical Procedures / methods*
Obesity / complications
Obesity, Morbid* / complications
Postoperative Complications / epidemiology*
Postoperative Complications / etiology*
Retrospective Studies
Spinal Fusion / adverse effects
Spinal Fusion / methods*