• David C Sing, John K Yue, Lionel N Metz, Ethan A Winkler, William R Zhang, Shane Burch, and Sigurd H Berven.
• *Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA †Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA.
• Spine. 2016 May 1; 41 (10): E632-40.

Study DesignRetrospective cohort analysis of risk factors in revision spine surgery using a prospectively collected database.ObjectiveTo examine the risk of developing early (30-day) complications across obesity level after adjusting for comorbidities in patients undergoing revision spine surgery.Summary Of Background DataPrior studies suggest obesity influences early complications after primary surgery. The association between obesity and early complications after revision surgery remains to be characterized.MethodsData were abstracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2012. Adult Caucasian patients undergoing removal/revision of instrumentation or exploration of fusion were included. Patients were categorized by WHO body mass index (BMI, kg/m): Non-Obese (18.5-29.9), Obese Class I (30-34.9), and Obese Class II/III (≥35). Univariate regression was performed to assess the predictive value of obesity level and baseline risk factors in the presence of at least one early complication, and significant predictors were entered into the multivariable model.ResultsOf 2538 patients, 57.6% were nonobese, 23% Obese Class I, and 19.4% Obese Class II/III. Obesity was associated with diabetes, hypertension, respiratory disease, and American Society of Anesthesiologists (ASA) score of 3-4 (all P < 0.001). BMI group (P = 0.01), older age (P = 0.008), functional dependence (P < 0.001), ASA 3-4 (P = 0.008), bleeding disorder (P = 0.04), and diabetes (P = 0.016) were identified as univariate predictors for early complications. In the multivariable model, higher BMI (P = 0.04), older age (P = 0.014), and functional dependence (P < 0.001) remained significant predictors for early complications. Notably, patients who were Obese Class II/III (OR 1.66, 95% CI [1.12-2.45]), age ≥75 (OR 1.83, [1.20-2.81]), and functionally dependent (OR 3.02 [1.85-4.94]) had significantly higher risk compared with their reference groups.ConclusionObesity is an independent risk factor for early complications after revision spine surgery. Although obesity may not contraindicate revision surgery, its status as a modifiable risk factor warrants disclosure and preoperative counseling to optimize outcomes.Level Of Evidence3.

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