TY - JOUR
T1 - Bariatric Surgery Population at Significantly Increased Risk of Spinal Disorders and Surgical Intervention Compared with Morbidly Obese Patients
AU - Passias, Peter G.
AU - Horn, Samantha R.
AU - Ihejirika, Yael U.
AU - Vasques-Montes, Dennis
AU - Segreto, Frank A.
AU - Bortz, Cole A.
AU - Brown, Avery E.
AU - Pierce, Katherine E.
AU - Alas, Haddy
AU - Poorman, Gregory W.
AU - Jalai, Cyrus M.
AU - Wang, Charles
AU - Buza, John A.
AU - Steinmetz, Leah
AU - Varlotta, Christopher G.
AU - Vira, Shaleen
AU - Diebo, Bassel G.
AU - Hassanzadeh, Hamid
AU - Lafage, Renaud
AU - Lafage, Virginie
N1 - Funding Information:
The NYSID was developed by the Healthcare Cost and Utilization Project with support from the Agency for Healthcare Research and Quality. NYSID contains patient information from billing codes and captures patients who are covered under Medicare, Medicaid or private insurance. It includes over 100 clinical and nonclinical variables that are derived from a hospital discharge abstract, including primary and secondary diagnoses and procedures, admission and discharge status, demographics including age, sex, race, payment source, charges, and hospital length of stay. The database utilizes the International Classification of Diseases Ninth Revision Clinical Modification codes (ICD-9-CM) to identify diagnoses and procedures. Unique patient linkage codes allow identification of multiple and return inpatient stays over time.
Publisher Copyright:
Copyright © 2020 Wolters Kluwer Health, Inc.
PY - 2020
Y1 - 2020
N2 - Introduction: Obesity is associated with acceleration of musculoskeletal degenerative diseases and functional impairment secondary to spinal disorders. Bariatric surgery (BS) is an increasingly common treatment for severe obesity but can affect bone and mineral metabolism. The effect of BS on degenerative spinal disorders is yet to be fully described. The aim of our study was to analyze changes in bariatric patients' risk for spinal degenerative diseases and spinal surgery. Methods: Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004-2013) using patient linkage codes. The incidence of degenerative spinal diagnoses and spinal surgery was queried using International Classification of Diseases, Ninth Revision (ICD)-9 codes for morbidly obese patients (ICD-9 278.01) with and without a history of BS. The incidence of degenerative spinal diagnoses and spinal surgery was determined using χ2 tests for independence. Logistic testing controlled for age, sex, and comorbidity burden. Results: A total of 18,176 patients were identified in the NYSID database with a history of BS and 146,252 patients were identified as morbidly obese without a history of BS. BS patients have a significantly higher rate of spinal diagnoses than morbidly obese patients without BS (19.3% vs. 8.1%, P<0.001). Bariatric patients were more likely to have spinal diagnoses and procedures than nonbariatric obese patients (P<0.001). This was mostly observed in lumbar spinal stenosis (5.0%), cervical disk herniation (3.3%), lumbar disk degeneration (3.4%), lumbar spondylolisthesis (2.9%), lumbar spondylosis (1.9%), and cervical spondylosis with myelopathy (2.0%). Spine procedure rates are higher for bariatric patients than nonbariatric overall (25.6% vs. 2.3, P<0.001) and for fusions and decompressions (P<0.001). When controlling for age, sex, and comorbidities (and diagnosis rate with regards to procedure rates), these results persist, with BS patients having a higher likelihood of spinal diagnoses and procedures. In addition, bariatric patients had a lower comorbidity burden than morbidly obese patients without a history of BS. Conclusions: Morbidly obese BS patients have a dramatically higher incidence of spinal diagnoses and procedures, relative to morbidly obese patients without BS. Further study is necessary to determine if there is a pathophysiological mechanism underlying this higher risk of spinal disease and intervention in bariatric patients, and the effect of BS on these rates following treatment. Level of Evidence: Level III.
AB - Introduction: Obesity is associated with acceleration of musculoskeletal degenerative diseases and functional impairment secondary to spinal disorders. Bariatric surgery (BS) is an increasingly common treatment for severe obesity but can affect bone and mineral metabolism. The effect of BS on degenerative spinal disorders is yet to be fully described. The aim of our study was to analyze changes in bariatric patients' risk for spinal degenerative diseases and spinal surgery. Methods: Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004-2013) using patient linkage codes. The incidence of degenerative spinal diagnoses and spinal surgery was queried using International Classification of Diseases, Ninth Revision (ICD)-9 codes for morbidly obese patients (ICD-9 278.01) with and without a history of BS. The incidence of degenerative spinal diagnoses and spinal surgery was determined using χ2 tests for independence. Logistic testing controlled for age, sex, and comorbidity burden. Results: A total of 18,176 patients were identified in the NYSID database with a history of BS and 146,252 patients were identified as morbidly obese without a history of BS. BS patients have a significantly higher rate of spinal diagnoses than morbidly obese patients without BS (19.3% vs. 8.1%, P<0.001). Bariatric patients were more likely to have spinal diagnoses and procedures than nonbariatric obese patients (P<0.001). This was mostly observed in lumbar spinal stenosis (5.0%), cervical disk herniation (3.3%), lumbar disk degeneration (3.4%), lumbar spondylolisthesis (2.9%), lumbar spondylosis (1.9%), and cervical spondylosis with myelopathy (2.0%). Spine procedure rates are higher for bariatric patients than nonbariatric overall (25.6% vs. 2.3, P<0.001) and for fusions and decompressions (P<0.001). When controlling for age, sex, and comorbidities (and diagnosis rate with regards to procedure rates), these results persist, with BS patients having a higher likelihood of spinal diagnoses and procedures. In addition, bariatric patients had a lower comorbidity burden than morbidly obese patients without a history of BS. Conclusions: Morbidly obese BS patients have a dramatically higher incidence of spinal diagnoses and procedures, relative to morbidly obese patients without BS. Further study is necessary to determine if there is a pathophysiological mechanism underlying this higher risk of spinal disease and intervention in bariatric patients, and the effect of BS on these rates following treatment. Level of Evidence: Level III.
KW - bariatric surgery
KW - morbid obesity
KW - spinal diagnoses rate
KW - spine surgery rate
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U2 - 10.1097/BSD.0000000000000960
DO - 10.1097/BSD.0000000000000960
M3 - Article
C2 - 32168118
AN - SCOPUS:85082081843
SN - 2380-0186
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
ER -