Thoracolumbar Fusion in Extreme Obesity: Complications and Patient-Reported Outcomes

Background Extreme obesity (class III) is defined by the Centers for Disease Control as a body mass index (BMI) value ≥40. Recent studies suggest that obese patients have poor outcomes after thoracolumbar spinal fusions. The objective of this study was to analyze 30-day adverse events and patient-reported outcomes (PROs) for this population.

Patients and Methods A retrospective chart review of spinal fusion surgeries performed at a single institution from 2006 to 2016 was executed. All patients had a preoperative BMI ≥40. Patient characteristics, including age, sex, BMI, American Society of Anesthesiologists (ASA) score, Charlson Comorbidity Index (CCI), and others, were collected. Thirty-day adverse events (complications, readmissions, reoperations, and mortality) and PROs (Oswestry Disability Index [ODI] and visual analog scale [VAS]) were recorded.

Results Fifty-six patients were identified, including 30 men (54%). Mean age was 55.7 years (range, 31–74 years). Mean BMI was 44.2 (range, 40.0–54.7). Mean ASA was 2.7 (range, 2–3), and mean CCI was 1.1 (range, 0–6). Mean number of fused levels was 2.3 (range, 1–14). Mean length of stay was 4.4 ± 2.1 days. Mean number of complications was 0.7 ± 1.1, with 30.4% of patients having had at least 1 complication. The 30-day all-cause readmission rate was 5.4%, and 30-day reoperation rate was 3.6%. For 30 patients (54%) with 1-year PROs, mean preoperative ODI was 65.2 ± 11.1, and mean preoperative VAS was 6.6 ± 1.6. Mean ODI change was −19.9 ± 20.1 (P < .001), and mean VAS change was −2.6 ± 2.3 (P < .001). A total of 15 patients (50%) achieved the minimum clinically important difference in ODI (12.8), with a mean follow-up of 18.9 months.

Conclusions Patients with extreme obesity who undergo thoracolumbar fusion have acceptable 30-day adverse events and potentially can achieve significant improvement in pain and disability.