More risks and complications for elective spine surgery in morbidly obese patients

BACKGROUND The vast majority of studies emphasize the greater morbidity/mortality for elective spine surgery in morbidly obese patients. METHODS This review focuses on the increased morbidity/mortality of performing elective spinal operations in morbidly obese patients. There are two definitions of morbid obesity; a body mass index (BMI) of equal to or greater than 35 plus two major comorbid factors (e.g., hypertension, diabetes, etc.) or a BMI (morbidly obese III) of =≥40 kg/m2. RESULTS For patients undergoing spinal surgery, morbid obesity increases perioperative morbidity/mortality for various reasons. The quality of preoperative and intraoperative imaging is often compromised potentially leading to mistaken preoperative diagnoses, and wrong level surgery. Resultant major technical surgical limitations include poor/inadequate operative exposure, and the risk of suboptimal placement of instrumentation There is also increased exposure to major perioperative complications such as deep venous thrombosis, pulmonary embolism, infection, pneumonia, cardiac complications, blindness in the prone position, brachial and lumbar plexus injuries, increased anesthetic risks (e.g., even using awake intubation/awake positioning), and postoperative wound seromas/hematomas. CONCLUSIONS Most of the spinal literature documents the marked increased perioperative morbidity/mortality for morbidly obese patients undergoing elective spine surgery. If elective surgery is warranted in these patients, the risks and timing of surgical intervention should include consideration of major preoperative weight loss strategies including bariatric procedures to optimize outcomes.