Increased body mass index (BMI) is not associated in postoperative complications following three-column osteotomy.

Wednesday, February 21, 2024

Presenting Author(s)

David J. Mazur-Hart, MD (he/him/his)

Clinical Fellow
University of California, San Francisco
San Francisco, CA, US

Co-Author(s)

Christopher P. Ames, MD

Neurosurgeon
University of California, San Francisco
San Francisco, California, United States
PC

Ping-Yeh Chiu, MD

Professor
Chang Gung Memorial Hospital, United States
Winward Choy, MD

Resident
University of California, San Francisco
San Francisco, CA, US
VD

Vedat Deviren, MD

Professor
University of California, San Francisco
San Francisco, California, United States

Disclosure(s):

David J. Mazur-Hart, MD: No financial relationships to disclose

Winward Choy, MD: No financial relationships to disclose

Introduction: Three-column osteotomies (3CO) are corrective maneuvers that allow for large changes in spinal alignment during deformity correction. There is debate in the field regarding proper patient selection and optimization prior to such an invasive operation. One such point of contention is body mass index (BMI). We performed a single-surgeon review of three column osteotomies over the course of a 15-year span to help describe complications and radiographic outcomes stratified by BMI.

Methods: Retrospective analysis of patients undergoing three-column osteotomy from 2006 to 2023 performed by the senior author. Collected variables included standard demographics, procedural outcomes, and radiographic measurements. Patients were excluded if preoperative BMI was not available. BMI categories were separated by CDC based guidelines of normal weight ( < 25), overweight (25-29.9), obese (30-34.9), and morbidly obese (35).

Results: There were 286 patients identified that were stratified into BMI groupings: < 25, 25-29.9, 30-34.9, and 35. The average age was 62.9, 65.6, 65.2, and 61.1, respectively. The proportion of male sex was 27.1%, 43.6%, 40.0%, and 37.5%, respectively. Average operative time was 335.2, 338.8, 356.6, and 341.0, respectively. Average length of stay (LOS) was 9.8, 9.2, 10.4, and 8.2, respectively. There was no statistical significance in age, sex, operative time, or LOS. There was also no significant difference between preoperative and postoperative SVA or PI-LL mismatch, but there was a trend towards greater deformity in the largest BMI category. There was no statistically significant difference in total patients that experience complications, in hardware complications, or in need for reoperation.

Conclusion : BMI should not factor into preoperative risk stratification planning for patients undergoing 3CO as patients who are obese should expect similar postoperative courses as those with normal BMI.