Asian Spine J.  2020 Oct;14(5):613-620. 10.31616/asj.2019.0236.

Rapid Bodyweight Reduction before Lumbar Fusion Surgery Increased Postoperative Complications

• Rudy HL
• Cho W
• Oster BA
• Tarpada SP
• Moran-Atkin E

• KMID: 2507905
• DOI: http://doi.org/10.31616/asj.2019.0236

Abstract

Study Design: Retrospective cohort study. Purpose: To determine the effects of massive weight loss on perioperative complications after lumbar fusion surgery (LFS). Overview of Literature: Patients who are obese are more likely to experience low back pain, which would require LFS. Nonetheless, they have a higher risk of perioperative complication development compared with individuals who are not obese.
Methods
Patients who underwent LFS at hospitals that participated in the National Surgical Quality Improvement Program database within the United States between 2005 and 2015. Outcomes included 30-day medical complications, surgical complications, and length of stay (LOS). We analyzed a total of 39,742 patients with the use of the International Classification of Disease, ninth revision codes. The patients were categorized in the following two groups: group 1, individuals with a history of massive weight loss within 6 months before LFS, and group 2, individuals without a history of massive weight loss before surgery. Massive weight loss was defined as loss of 10% of total body weight. Patients with a history of malignancy or chronic disease were excluded from the study. Patients in each group were randomly matched based on age, gender, sex, smoking status, and body mass index. Paired two-tailed Student t -tests were used to compare the outcomes.
Results
Of the 39,742 patients identified, 129 (0.32%) met the criteria for inclusion in the weight loss group (WL group) and were successfully matched to individuals in the non-weight loss group (non-WL group). Compared with the non-WL group, the WL group had a significantly longer LOS (9.7 vs. 4.0 days, p <0.05), higher surgical site infections (SSIs) (8.0 vs. 3.0, p <0.05), increased number of blood transfusions (40.0 vs. 20.0, p <0.05), and greater deep vein thrombosis (DVTs) (5.0 and 0.00, p <0.05).
Conclusions
On a nationwide scale, rapid weight loss before LFS is associated with a higher rate of postoperative complications, including SSI and DVTs, longer average LOS, and more frequent blood transfusions.

Keyword

Lumbar vertebrae; Postoperative complications; Bariatric surgery; Lumbar region