Obesity Is Associated with an Increased Rate of Incidental Durotomy in Lumbar Spine Surgery

Christopher A. Burks, Brian C. Werner, Scott Yang, Adam L. Shimer

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Study Design. Retrospective database analysis. Objective. To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery. Summary of Background Data. There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed. Methods. A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ2 test was used to assess for statistical significance. Results. The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures. Conclusion. This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population. Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)500-504
Number of pages5
JournalSpine
Volume40
Issue number7
DOIs
StatePublished - Apr 1 2015

Fingerprint

Spine
Obesity
Decompression
Databases
Laminectomy
Documentation
Comorbidity
Body Mass Index
Odds Ratio
Demography
Confidence Intervals
Population

Keywords

  • body mass index
  • cerebrospinal fluid leak
  • complication
  • database
  • dural tear
  • durotomy
  • incidence
  • lumbar spine surgery
  • morbid obesity
  • obesity
  • risk factor

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Obesity Is Associated with an Increased Rate of Incidental Durotomy in Lumbar Spine Surgery. / Burks, Christopher A.; Werner, Brian C.; Yang, Scott; Shimer, Adam L.

In: Spine, Vol. 40, No. 7, 01.04.2015, p. 500-504.

Research output: Contribution to journalArticle

Burks, Christopher A. ; Werner, Brian C. ; Yang, Scott ; Shimer, Adam L. / Obesity Is Associated with an Increased Rate of Incidental Durotomy in Lumbar Spine Surgery. In: Spine. 2015 ; Vol. 40, No. 7. pp. 500-504.
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AB - Study Design. Retrospective database analysis. Objective. To determine the impact of obesity on the rate of incidental durotomy in lumbar spine surgery. Summary of Background Data. There is a paucity of data on the overall impact of obesity on the rate of incidental durotomy in lumbar spine surgery, specifically with regard to the type of procedure performed. Methods. A large administrative database was queried for all patients who underwent lumbar spine surgery for decompression and/or fusion. They were then stratified into separate cohorts on the basis of body mass index and by procedural codes. Documentation of incidental durotomy was noted. Patient demographics and associated comorbidities were assessed. Odds ratios and 95% confidence intervals were calculated and χ2 test was used to assess for statistical significance. Results. The incidental durotomy ranged from 0.5% to 2.6%, with the highest rates observed in multilevel laminectomies and revision decompressions in the obese and morbidly obese groups. For patients who underwent decompression only procedures, nonobese patients had a significantly lower rate of durotomy than the obese and morbidly obese cohorts. For patients who underwent fusion with or without decompression, there was a significantly increased rate of durotomy in obese patients compared with nonobese patients. The morbidly obese cohort also had significantly higher rates of incidental durotomy than the nonobese cohort in both revision decompression and revision fusion procedures. Conclusion. This analysis of a large administrative database demonstrates that obesity is associated with increased rates of incidental durotomy in lumbar spine surgery. Furthermore, obesity, in association with increasing complexity of the procedure, increases the rate of incidental durotomy in lumbar spine surgery. Surgeons must be aware of these increased risks as the rate of obesity increases in the population. Level of Evidence: 3.

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