The impact of BMI on operating room time, blood loss, and hospital stay in patients undergoing spinal fusion.

OBJECTIVE: Obesity affects not only the health of an individual but society as a whole and especially the healthcare system. Healthcare providers are faced with challenges to deliver adequate care in this resource-limited environment, assure safety, and accommodate the increasing population of overweight patients. The effects of increased body mass index (BMI) on clinical outcomes, complications, health care resource utilization, effectiveness of minimally invasive approaches, and perioperative parameters in spine surgeries have all been previously studied, but the majority of these findings are conflicting rather than conclusive. The main objective of this study was to analyze the impact of BMI on perioperative outcomes in patients undergoing one- to two-level elective TLIF procedures for degenerative spine conditions and to identify the need to modify internal hospital operational planning, team organization, and patient flow processes to accommodate patients who are overweight.

PATIENTS AND METHODS: A single-center retrospective case-review study was completed. The study included 172 consecutive patients who underwent elective one- or two-level transforaminal lumbar interbody fusions (TLIF). The patients were categorized as obese if they had BMI value that was equal to or greater than 30 kg/m2 . Outcome measures included surgical and non-operative operating room (OR) time, length of stay (LOS), and estimated blood loss (EBL). Multiple regression analyses were performed to determine if BMI had an effect on perioperative parameters while controlling for independent variables.

RESULTS: BMI did not have a statistically significant effect on surgical (p = 0.13) and non-operative OR time (p = 0.82). Obese patients remained hospitalized on average 0.45 ± 0.25 days longer (p = 0.037) and lost 71.8 ± 26.3 mL more blood (p = 0.007).

CONCLUSIONS: Obesity is associated with longer hospitalization and more intraoperative blood loss, but may have no impact on surgical and non-operative OR times in patients undergoing one- and two-level TLIFs.