Medical Student Carle Illinois College of Medicine, Minnesota, United States
Introduction: Obesity in the US has been climbing, on par with the rise in bariatric surgery. Therefore, the incidence of patients undergoing elective spine surgery who have had bariatric surgery in the past is also rising. The effects of bariatric surgery on the outcomes of spine surgery have only been explored in studies with notable limitations.
Methods: A PRISMA-adherent search was performed on peer-reviewed articles from four article databases. Studies evaluating outcomes of patients receiving bariatric surgery prior to elective spine surgery were compared to obese and non-obese controls. A network meta-analysis was performed to assess the outcomes of bariatric patients receiving elective spine surgery compared to obese and non-obese control groups.
Results: Four studies consisting of 330,226 patients were included - 34,962 were bariatric patients, 145,069 were obese control patients, and 150,195 were non-obese patients who underwent spine surgery. DVT/PE, renal, cardiac, and total wound were more likely to occur in obese patients than in bariatric patients (OR=0.31, 0.27, 0.44, 0.62 respectively; p< 0.05). Additionally, 90-day readmission for bariatric patients was less likely than for obese patients (OR=0.47, p< 0.05). Mortality was lower amongst bariatric patients receiving spine surgery compared to obese control patients (OR=0.14, p< 0.05). Hospitalization length was less in bariatric patients compared to obese control patients (OR=0.18, p< 0.05). NMA found a significant difference between bariatric patients and non-obese control patients in total wound complications and 90-readmission. Bariatric patients were more likely to experience wound complications and be readmitted within 90 days of operation compared to non-obese patients (OR=4.18, p< 0.05 wound; OR=5.08, p< 0.05 readmission).
Conclusion : Our NMA suggests that bariatric patients undergoing elective spine surgery have generally better post-surgical outcomes than obese patients undergoing spine surgery. However, bariatric patients compared to non-obese patients have a higher likelihood of readmission in 90 days and a higher wound complication likelihood.
