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The Impact of Body Mass Index (BMI) on 30-day Outcomes Following Posterior Spinal Fusion in Neuromuscular Scoliosis

Malik, Azeem Tariq MBBS; Tamer, Robert MPA, MPH; Yu, Elizabeth MD; Kim, Jeffery MD; Khan, Safdar N. MD

doi: 10.1097/BRS.0000000000003084

Study Design. Retrospective.

Objective. Assess the impact of varying severity of BMI on 30-day outcomes following posterior spinal fusions in neuromuscular scoliosis.

Summary of Background Data. Obesity in the pediatric population is shown to be associated with adverse outcomes across varying specialties. The weight-outcome relationship in neuromuscular scoliosis has not been thoroughly investigated.

Methods. The 2012–2016 American College of Surgeons – National Surgical Quality Improvement (ACS-NSQIP) database was queried using Current Procedural Terminology codes 22800, 22802, and 22804 to identify patients undergoing posterior spinal fusion for neuromuscular scoliosis only. BMI was classified into four groups based on the Center for Disease Control (CDC) BMI-for-age percentile chart – Normal weight (BMI ≥5th to <85th percentile), Underweight (<5th percentile), Overweight (≥85th to <95th percentile) and Obese (≥95th percentile). Multivariate regression models were built to understand the impact of varying BMI severity classes on 30-day outcomes.

Results. A total of 1291 patients underwent posterior spinal fusion for neuromuscular scoliosis. A total of 695 (53.8%) were normal weight, 286 (22.2%) were underweight, 145 (11.2%) were overweight, and 165 (12.8%) were obese. Obese patients versus normal weight patients were at a significantly higher risk of surgical site infections (OR 2.15; P = 0.035), wound dehiscence (OR 1.58; P = 0.037), urinary tract infections (OR 3.41; P = 0.010), and 30-day readmissions (OR 1.94; P = 0.029). Of note, overweight versus normal weight individuals had higher odds of cardiopulmonary complications (OR 8.82; P = 0.024). No significant associations were seen for varying BMI and other 30-day outcomes.

Conclusions. Obese neuromuscular patients undergoing PSF have higher odds of experiencing adverse outcomes, particularly surgical site infections, urinary tract infections, and readmissions. Providers should promote prevention strategies, such as dietary modification and/or early physical activity in these high-risk patients to minimize the risks of experiencing complications in the acute postoperative period.

Level of Evidence: 3

Obese patients undergoing posterior spinal fusion for neuromuscular scoliosis were at a significantly higher risk of surgical site infections, wound dehiscence, urinary tract infections, and 30-day readmissions. Providers should promote weight-gain prevention strategies and medical optimization in these high-risk patients.

Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.

Address correspondence and reprint requests to Safdar N. Khan, MD, The Benjamin R. and Helen Slack Wiltberger Endowed Chair in Orthopaedic Spine Surgery, Associate Professor and Chief, Division of Spine Surgery, Department of Orthopaedics, Adjunct Associate Professor, Department of Integrated Systems Engineering, Clinical Faculty, Spine Research Institute (, Wexner Medical Center at The Ohio State University, Columbus, OH; E-mail:

Received 2 November, 2018

Revised 28 February, 2019

Accepted 28 March, 2019

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.