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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(03): 442-447
DOI: 10.1055/s-0042-1756627
Original Article

Impact of Obesity on Perioperative Complications on Treatment of Spinal Metastases: A Multicenter Surveillance Study from the German Spine Registry (DWG-Register)

Juan Manuel Vinas-Rios
1   Department of Spinal Surgery, Sanaklinik Offenbach am Main, Offenbach am Main, Germany
,
Michael Rauschmann
1   Department of Spinal Surgery, Sanaklinik Offenbach am Main, Offenbach am Main, Germany
,
Richard Sellei
2   Department of Traumatology, Sanaklinik Offenbach am Main, Offenbach am Main, Germany
,
Mohammad Arabmotlagh
1   Department of Spinal Surgery, Sanaklinik Offenbach am Main, Offenbach am Main, Germany
,
Fatima Medina-Govea
3   Department of Clinical Epidemiology, UASLP, San Luis Potosi, Mexico
,
Frerk Meyer
4   Department of Spinal Surgery, University Clinic for Neurosurgery, Evangelisches Krankenhaus, Oldenburg, Germany
,
DWG-Register study group › Author Affiliations Funding None.
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Abstract

Background The spine is a common location for the development of primary and metastatic tumors, spinal metastases being the most common tumor in the spine. Spinal surgery in obesity is challenging due to difficulties with anesthesia, intravenous access, positioning, and physical access during surgery. The objective was to investigate the effect of obesity on perioperative complications by discharge in patients undergoing surgery for spinal metastases.

Methods Retrospective analysis of data from the DWG-register on patients undergoing surgery for metastatic disease in the spine from January 2012 to December 2016. Preoperative variables included obesity (≥ 30 kg/m2), age, gender, and smoking status. In addition, the influence of pre-existing medical comorbidity was determined, using the American Society of Anesthesiologists (ASA) score.

Results In total, 528 decompressions with and without instrumentation undergoing tumor debulking, release of the neural structures, or tumor extirpation in metastatic disease of the spine were identified; 143 patients were obese (body mass index [BMI] ≥ 30 kg/m2), and 385 patients had a BMI less than 30 kg/m2. The mean age in the group with BMI 30 kg/m2 or higher (group 1) was 67 years (56.6%). In the group with BMI less than 30 kg/m2 (group 2), the mean age was 64 years. Most of the patients had preoperatively an ASA score of 3 and 4 (patients with severe general disease). The likelihood of being obese in the logistic regression model seems to be protective by 47.5-fold for blood loss 500 mL or higher. Transfusions occurred in 321/528 (60.7%) patients (group 1, n = 122 and group 2, n = 299; p = 0.04). A total of 19 vertebroplasties with percutaneous stabilization (minimally invasive spine [MIS]), 6 vertebroplasties, and 31 MIS alone were identified. The variables between these groups, with exception of preoperative status (ASA-score; p = 0.02), remained nonsignificant.

Conclusion Obese patients were predisposed to have blood loss more than 500 mL more often than nonobese patients undergoing surgery for spinal metastases but with perioperative blood transfusions, invasiveness, nor prolonged hospitalization. Early postoperative mobilization and a low threshold for perioperative venous thromboembolism (VTE) are important in obese patients to appropriately diagnose, treat complications, and minimize morbidity.

Keywords

obesity - metastases - spinal surgery - register

Informed Consent

Informed consent was obtained from all individual participants included in the study.


Availability of Data and Material

The datasets generated and/or analyzed during the current study are available in the (DWG-register home page) repository [https://dwg.memdoc.org/].




Publication History

Article published online:
07 October 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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