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World J Crit Care Med. Feb 4, 2016; 5(1): 83-88
Published online Feb 4, 2016. doi: 10.5492/wjccm.v5.i1.83
Critical care of obese patients during and after spine surgery
Hossein Elgafy, Ryan Hamilton, Nicholas Peters, Daniel Paull, Ali Hassan
Hossein Elgafy, Ryan Hamilton, Nicholas Peters, Daniel Paull, Departments of Orthopedic, University of Toledo Medical Center, Toledo, OH 43614-5807, United States
Ali Hassan, Departments of Anesthesia, University of Toledo Medical Center, Toledo, OH 43614-5807, United States
Author contributions: All the authors contributed in outlining the manuscript, gathering the data, and writing the manuscript.
Conflict-of-interest statement: None of the authors have any financial and other conflicts of interest that may bias the current study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hossein Elgafy, MD, MCH, FRCSED, FRCSC, Department of Orthopaedics, University of Toledo Medical Centre, 3065 Arlington Avenue, Toledo, OH 43614-5807, United States. hkelgafy@aol.com
Telephone: +1-419-3833515 Fax: +1-419-3833526
Received: July 30, 2015
Peer-review started: July 31, 2015
First decision: October 8, 2015
Revised: December 4, 2015
Accepted: December 18, 2015
Article in press: December 21, 2015
Published online: February 4, 2016
Processing time: 177 Days and 0.6 Hours
Abstract

Obesity is one of the most prevalent health problems facing the United States today, with a recent JAMA article published in 2014 estimating the prevalence of one third of all adults in the United States being obese. Also, due to technological advancements, the incidence of spine surgeries is growing. Considering these overall increases in both obesity and the performance of spinal surgeries, it can be inferred that more spinal surgery candidates will be obese. Due to this, certain factors must be taken into consideration when dealing with spine surgeries in the obese. Obesity is closely correlated with additional medical comorbidities, including hypertension, coronary artery disease, congestive heart failure, and diabetes mellitus. The pre-operative evaluation may be more difficult, as a more extensive medical evaluation may be needed. Also, adequate radiographic images can be difficult to obtain due to patient size and equipment limitations. Administering anesthesia becomes more difficult, as does proper patient positioning. Post-operatively, the obese patient is at greater risk for reintubation, difficulty with pain control, wound infection and deep vein thrombosis. However, despite these concerns, appropriate clinical outcomes can still be achieved in the obese spine surgical candidate. Obesity, therefore, is not a contraindication to spine surgery, and appropriate patient selection remains the key to obtaining favorable clinical outcomes.

Keywords: Obesity; Spine sugary; Critical care

Core tip: Obesity is one of the most prevalent health problems facing the United States today. Due to technological advancements, the incidence of spine surgeries is also growing. This is particularly true for spinal fusion procedures, as rates were noted to triple from 1990 to 2000. There are potential increased complication risks during and after spine surgery due to associated comorbidities. Spine surgery can be performed safely in obese patients with appropriate management of comorbidities and proper patient selection.