Impact of Elevated Body Mass Index on Surgical Outcomes for Patients Undergoing Cervical Fusion Procedures: A Systematic Review and Meta-Analysis.

ABSTRACT

To investigate whether high body mass index (BMI) had adverse effects on the postoperative outcomes for patients who underwent anterior or posterior cervical fusion procedures. A literature search were conducted in PubMed, Embase, and Web of Science. Comparative or controlled studies that examined the influences of high BMI on postoperative outcomes after cervical fusion procedures were included. Using a fixed-effect model or random-effect model, the effects of high BMI were determined by weight mean difference (WMD) with 95% confidence interval (95% CI) or risk ratio (RR) with 95% CI. A total of seven studies were included in this meta-analysis. The pooled estimate showed that high BMI was associated with longer hospital stay (WMD = 1.61 days, 95% CI 0.51, 2.71; P = 0.004), longer surgical time (WMD = 4.55, 95% CI 1.04, 8.07; P = 0.011), higher mortality rate (RR = 3.01, 95% CI 2.75, 3.29; P < 0.001), and higher postoperative rates of cardiac complication (RR = 1.30, 95% CI 1.11, 1.52; P = 0.001), deep venous thromboembolism (RR = 2.29, 95% CI 1.36, 3.86; P = 0.002), and wound complication (RR = 1.69, 95% CI 1.26, 2.28; P < 0.001). However, there was no significant differences between high and normal BMI groups in terms of Neck Disability Index (WMD = 1.49, 95% CI -2.34, 5.32; P = 0.447), SF-36 Mental Component Score (MCS) (WMD = -0.87, 95% CI -2.09, 0.35; P = 0.164), overall complications (RR = 1.18, 95% CI 0.80, 1.76; P = 0.399), central nervous system (CNS) complications (RR = 0.68, 95% CI 0.17, 2.76; P = 0.586), pulmonary complications (RR = 1.46, 95% CI 0.87, 2.46; P = 0.150), and septic complications (RR = 0.87, 95% CI 0.32, 2.38; P = 0.785).High BMI seemed to be associated with longer hospital stay, surgical time, and higher postoperative complication rates compared to normal BMI. Therefore, high BMI patients should be counseled carefully regarding the risk of postoperative complications and surgical outcomes after cervical fusion procedures.