Prior bariatric surgery lowers complication rates following spine surgery in obese patients
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Bariatric surgery (BS) is an increasingly common treatment for morbid obesity that has the potential to effect bone and mineral metabolism. The effect of prior BS on spine surgery outcomes has not been well established. The aim of this study was to assess differences in complication rates following spinal surgery for patients with and without a history of BS.
Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years 2004–2013. BS patients and morbidly obese patients (non-BS) were divided into cervical and thoracolumbar surgical groups and propensity score matched for age, gender, and invasiveness and complications compared.
One thousand nine hundred thirty-nine spine surgery patients with a history of BS were compared to 1625 non-BS spine surgery patients. The average time from bariatric surgery to spine surgery is 2.95 years. After propensity score matching, 740 BS patients were compared to 740 non-BS patients undergoing thoracolumbar surgery, with similar comorbidity rates. The overall complication rate for BS thoracolumbar patients was lower than non-BS (45.8% vs 58.1%, P < 0.001), with lower rates of device-related (6.1% vs 23.2%, P < 0.001), DVT (1.2% vs 2.7%, P = 0.039), and hematomas (1.5% vs 4.5%, P < 0.001). Neurologic complications were similar between BS patients and non-BS patients (2.3% vs 2.7%, P = 0.62). For patients undergoing cervical spine surgery, BS patients experienced lower rates of bowel issues, device-related, and overall complication than non-BS patients (P < 0.05).
Bariatric surgery patients undergoing spine surgery experience lower overall complication rates than morbidly obese patients. This study warrants further investigation into these populations to mitigate risks associated with spine surgery for bariatric patients.
KeywordsBariatric surgery Spine surgery Complications Morbid obesity
Acute respiratory distress syndrome
Body mass index
Deep vein thrombosis
International classification of diseases ninth revision clinical modification
Length of stay
New York State inpatient database
Peripheral vascular disease
Compliance with ethical standards
Conflict of interest
Dr. Passias reports personal fees from Medicrea, personal fees from SpineWave, non-financial support from Allosource, personal fees from Zimmer Biomet, personal fees from Globus, grants from CSRS, and personal fees from Aesculap, outside the submitted work. Dr. Sciubba reports consulting for Medtronic, DePuy Synthes, Stryker, NuVasive, and K2M, outside the submitted work. Dr. Hassanzadeh reports consulting for NuVasive, research support from Pfizer, and grant from Orthofix, outside the submitted work. Dr. Lafage reports stock ownership of Nemaris INC, speaking and/or teaching arrangements from NuVasive, DePuy Spine, Nemaris INC, Medicrea, and board of directors for Nemaris INC, and grants from SRS, NIH, and DePuy Spine, outside the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical review committee statement
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.
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