Complication Rates, Operative Times, and Hospital Costs Following Anterior Cervical Discectomy and Fusion in Obese Versus Nonobese Patients: A Systematic Review and Meta-Analysis.

Abstract

Systematic review and meta-analysis. To compare complication rates, operative times and hospital costs following anterior cervical discectomy and fusion (ACDF) in obese versus nonobese patients. Even though ACDF is one of the most commonly performed spinal surgical procedures in the United States, the literature remains conflicted on whether outcomes differ between obese and nonobese patients. To date, no meta-analysis has systematically combined existing studies. The PRISMA guidelines were followed to identify all comparative studies that reported patient and hospital outcomes. Primary outcomes included immediate postoperative complication rates, operative (skin-to-skin) times, and total hospital costs. Secondary outcomes included estimated blood loss, length of stay, readmission and reoperation rates. A total of 10 studies with 1,489,746 patients (161,541 obese; 1,328,205 nonobese) met the inclusion criteria. The mean age ranged from 50 to 60.9 years; 47.7% of the participants were male, and the mean follow-up period was 26 months. Postoperative dysphagia (obese 4.3%; nonobese 3.6%; OR: 1.28; CI: 1.25-1.32; I2: 0%, P<0.0001) and DVT/PE rates (0.3% vs. 0.2%; OR: 1.59; CI: 1.02-2.48; I2: 92%, P=0.04) were higher in the obese group. In addition, length of stay (mean difference: 0.28 d; CI: 0.11-0.44; I2: 48%, P=0.001) and total hospital costs (mean difference: $607.2; CI: $67-$1147.3; I2: 70%, P=0.03) were slightly higher in the obese group. Postoperative anemia (P=0.9), GU (P=0.2), respiratory (P=0.3), cardiac (P=0.7), wound complications (P=0.4), aggregate complication rates (P=0.4), readmission rates (P=0.97), reoperation rates (P=0.2), operative times (P=0.1), and estimated blood loss (P=0.2) were comparable among groups. In this systematic review, morbidity and complication rates were generally similar between obese and nonobese patients undergoing ACDF. Even though the obese group was associated with slightly higher odds of dysphagia, DVT/PE, longer hospital stays, and increased total hospital costs, the clinical significance of these findings is uncertain.