, Volume 471, Issue 4, pp 1230-1235
Date: 29 Nov 2012

Obesity Negatively Affects Spinal Surgery in Idiopathic Scoliosis

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Topic
Spine

Abstract

Background

Are obese patients with idiopathic scoliosis undergoing spinal surgery at higher risk for perioperative complications? This is not clearly understood. One previous study showed a greater preoperative thoracic kyphosis but no increase in perioperative complications.

Questions/purposes

We asked whether obese adolescents with idiopathic scoliosis have more perioperative complications and decreased curve correction.

Methods

We retrospectively reviewed 478 patients with idiopathic scoliosis operated on from 1998 to 2010. There were 236 (187 females, 49 males) with a mean age of 14 years (range, 11–22 years) who met the inclusion criteria. Demographic data, radiographic measurements, perioperative data, and major and minor complications were recorded. The BMI percentile (BMI%) defined two patient groups: healthy weight (BMI% < 85) (n = 181) and obese (BMI% ≥ 85) (n = 55). The preoperative curves were similar in the two groups. Minimum followup was 2 years (mean, 6 years; range, 2–14 years).

Results

Postoperatively, the mean major curve was smaller for healthy-weight patients (20°; range, 8°–36°) than for obese patients (23.2°; range, 12°–56°), as was the mean kyphosis (31.1° [range, 10°–56°]) versus 36° [range, 15°–33°], respectively). The postoperative lordosis was similar in both groups. Increased BMI% correlated with increased operative time, intraoperative blood loss, amount of intraoperative crystalloids, and difficulty with administration of spinal anesthesia.

Conclusions

Obese patients are at higher risk for perioperative complications when undergoing spinal deformity surgery. Counseling should be done with the patient and family and weight loss recommended before surgery.

Level of Evidence

Level IV, prognostic study. See Instructions for Authors for a complete description of levels of evidence.

One or more of the authors (GHT) certifies that he is an unpaid consultant for SpineForm LLC (Cincinnati, OH, USA), OrthoPediatrics Corp (Warsaw, IN, USA), and K2 M, Inc (Leesburg, VA, USA). Each of the remaining authors certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.