Obesity means more Spine Surgery Complications. Surgeons cannot be politically correct about Obesity. The truth is Obesity makes surgery more difficult, and less successful.
In the April 1, 2015 Edition of Spine, Dr. Burks, from the University of Virginia reviewed the data on Obesity and the associated rates of Incidental Durotomy during Lumbar Surgery. It is well know that obesity has been associated with increased rates of complications such as wound infection, blood loss, and even mortality. Likewise, Obesity is associated with longer surgery times, higher costs, and greater risk of developing medical events such as heart attack, breathing issues, and blood clots. To complete the analysis, it means worse outcomes.
Dr. Burks and colleagues looked a the data regarding lumbar spine surgery, and compared the obese ( body mass index greater than 30), the morbidly obese (BMI greater than 40), and normal body weight patients.
The data analysis shows non obese patients to have a significantly less rate of these incidental durotomies.
As a spine surgeon, I found this data interesting, as previously, it was thought these dural openings are most associated with more complicated, or revision type surgeries. But this paper shows that even within groups of patients with revision, or more complicated surgeries, there is still a higher rate of dural openings when stratified by non-obese vs obese.
As a Spine Surgeon, I know that obesity is definitely a factor in terms of planning the surgery, counseling the patient, and predicting an outcome. As I have been in practice for more than 20 years, I usually counsel obese patients to try to lose weight before any elective surgery. In a fair number of instances, the weight loss itself took care of the problem and surgery was cancelled. To me, sometimes, the obesity, and the associated medical conditions such as heart disease, diabetes, and diffuse arthritis makes the risk of surgery not worth any anticipated improvements. In that situation, I would advise against surgery.
While I cannot counsel obese patients on HOW to lose the weight, I certainly can counsel obese patients when the risks overshadow the chances of a successful surgery. It makes for a difficult conversation. Unfortunately, not everyone will accept my recommendations against surgery. At the same time, I am sure Obese patients can find Surgeons willing to take on the greater risks. Just understand, another Surgeon will not take away the risks associated with your obesity, or your medical conditions. In life or death matters, the risk should be accepted. In elective surgery, the risk should be discussed, and quantified.
- Burks CA, Werner BC, Yang S, Shimer AL. Obesity is associated with an increased rate of incidental durotomy in lumbar spine surgery. Spine (Phila Pa 1976). 2015 Apr 1;40(7):500-4. PubMed PMID: 25599288