Morbid obesity ups complication rate in spinal fusion surgery

To investigate whether morbid obesity impacts rates of complications and hospital charges in patients undergoing spinal fusion, Paul A. Kalanithi, M.D., from Stanford University Hospitals and Clinics in California, and colleagues retrospectively analyzed all spinal fusions performed in California from 2003 to 2007. Data from the Healthcare Cost and Utilization Project's California State Inpatient Databases were used to identify normal-weight and morbidly obese patients admitted for four types of spinal fusion: anterior cervical, posterior cervical, anterior lumbar, and posterior lumbar.

The researchers found that, of the 84,607 admissions, 1,455 patients were morbidly obese. Morbid obesity correlated with higher in-hospital complication rates (13.6 versus 6.9 percent), which were seen across nearly all complication types, including cardiac, renal, pulmonary, and wound complications. Mortality was slightly, but significantly, higher among the morbidly obese (0.41 versus 0.13 percent; P < 0.01). Average hospital costs were significantly higher ($108,604 versus $84,861) and length of stay significantly longer (4.8 versus 3.5 days) for the morbidly obese. In posterior cervical fusions, all effects were less pronounced. In anterior cervical and posterior lumbar fusions, morbid obesity was the most significant predictor of complications.

"Morbid obesity seems to increase the risk of multiple complication types in spinal fusion surgery, most particularly in anterior cervical and posterior lumbar approaches," the authors write.

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