Alana J. Green

Elevated Patient Body Mass Index Does Not Negatively Affect Self-Reported Outcomes of Thoracolumbar Surgery: Results of a Comparative Observational Study with Minimum 1-Year Follow-Up

Study Design Retrospective study. Objective Quantify the effect of obesity on elective thoracolumbar spine surgery patients. Methods Five hundred consecutive adult patients undergoing thoracolumbar spine surgery to treat degenerative pathologies with minimum follow-up of at least 1 year were included. Primary outcome measures included Numerical Rating Scales for back and leg pain, the Short Form 36 Physical Component Summary and Mental Component Summary, the modified Oswestry Disability Index, and patient satisfaction scores collected preoperatively and at 3, 6, 12, and 24 months postoperatively. Secondary outcome measures included perioperative and postoperative adverse events, postoperative emergency department presentation, hospital readmission, and revision surgeries. Patients were grouped according to World Health Organization body mass index (BMI) guidelines to isolate the effect of obesity on primary and secondary outcome measures. Results Mean BMI was 30 kg/m2, reflecting a significantly overweight population. Each BMI group reported statistically significant improvement on all self-reported outcome measures. Contrary to our hypothesis, however, there was no association between BMI group and primary outcome measures. Patients with BMI of 35 to 39.99 visited the emergency department with complaints of pain significantly more often than the other groups. Otherwise, we did not detect any differences in the secondary outcome measures between BMI groups. Conclusions Patients of all levels of obesity experienced significant improvement following elective thoracolumbar spine surgery. These outcomes were achieved without increased risk of postoperative complications such as infection and reoperation. A risk–benefit algorithm to assist with surgical decision making for obese patients would be valuable to surgeons and patients alike.

Avoidable Emergency Department Utilization Within 6 Months Following Elective Thoracolumbar Spine Surgery for Degenerative Pathologies

Study Design: Retrospective study. Objective: To identify prevalence of, reasons for, and predictors of emergency department (ED) utilization 6 months following elective thoracolumbar spine surgery. Methods: A retrospective review of a patient database was conducted (N = 577). Visits were divided by orthopedic spinal surgeons into (1) avoidable ED visit, (2) appropriate/no visit, and (3) unrelated visit. Measures: Demographics, pain scores, patient characteristics, and surgical factors. Results: A total of 14.38% of patients made an ED visit the majority for avoidable reasons (11.43%). Avoidable ED visits were predominately attributed to pain (45.5%) and physiology-related issues (50.0%). Significant differences in the Numerical Rating Scale–leg pain (NRS-L); U = 13 931, P = .031) were found. Patients with avoidable visits had higher leg pain prior to surgery than those without an avoidable visit. Marital status was also statistically significant, χ2(2, N = 535) = 8.189, P = .017. Patients were more likely to make an avoidable postoperative ED visit if they were either single or divorced/separated compared to patients who were married. A multivariate logistic regression model including NRS-L and marital status was statistically significant, χ2(3) = 10.14, P = .017; however only explained 3.7% of the variance. Conclusion: A large percentage of elective thoracolumbar surgery patients returned to the ED within 6 months for avoidable reasons. Patients likely to make avoidable visits could not be identified prior to surgery in a clinically meaningful way. Reasons for patients returning to the ED for avoidable reasons focused on pain management and minor physiological symptoms. Enhanced presurgical education may manage postsurgical expectations helping to prevent avoidable ED visits.