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Perioperative morbidity and complications in minimal access surgery techniques in obese patients with degenerative lumbar disease.

ABSTRACT: The medical profession is increasingly confronted with the epidemic phenomenon of obesity. Its impact on spine surgery is not quite clear. Published data concerning the use of minimally invasive surgery (MIS) in the spine among obese patients is scarce. The purpose of the present retrospective study was to evaluate perioperative as well as postoperative complication rates in MIS fusion of the lumbar spine in obese, overweight and normal patients classified according to their body mass index. Lumbar MIS fusion was performed by means of TLIF procedures and/or posterolateral fusion alone. A laminotomy was performed in patients with spinal stenosis. Of 72 patients, 39 underwent additional laminotomy for spinal stenosis. No differences were registered in respect of the numbers of fused segments or cages. Any harmful event occurring peri- or postoperatively was noted and included in the statistical analysis. No infection at the site of surgery or severe wound healing disorder was encountered. We registered no difference in blood loss, drainage, or the length of the hospital stay between the three BMI groups. We also observed no difference in complication rates between the three groups. This study confirms the low soft tissue damage of minimal access surgery techniques, which is an important type of surgery in obese patients. The smaller approach helps to minimize infections and wound healing disorders. Moreover, deeper regions of wounds are clearly visualized with the aid of tubular retractors.

SUBMITTER: Senker W

PROVIDER: S-EPMC3176708 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Perioperative morbidity and complications in minimal access surgery techniques in obese patients with degenerative lumbar disease.

Senker Wolfgang W Meznik Christian C Avian Alexander A Berghold Andrea A

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 20110125 7

The medical profession is increasingly confronted with the epidemic phenomenon of obesity. Its impact on spine surgery is not quite clear. Published data concerning the use of minimally invasive surgery (MIS) in the spine among obese patients is scarce. The purpose of the present retrospective study was to evaluate perioperative as well as postoperative complication rates in MIS fusion of the lumbar spine in obese, overweight and normal patients classified according to their body mass index. Lum ...[more]

PMID: 21264675

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Project description:Study designRetrospective database analysis.ObjectiveTo assess the effect glycemic control has on perioperative morbidity and mortality in patients undergoing elective degenerative lumbar spine surgery.Summary of background dataDiabetes mellitus (DM) is a prevalent disease of glucose dysregulation that has been demonstrated to increase morbidity and mortality after spine surgery. However, there is limited understanding of whether glycemic control influences surgical outcomes in patients with DM undergoing lumbar spine procedures for degenerative conditions.MethodsThe Nationwide Inpatient Sample was analyzed from 2002 to 2011. Hospitalizations were isolated on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification, procedural codes for lumbar spine surgery and diagnoses codes for degenerative conditions of the lumbar spine. Patients were then classified into 3 cohorts: controlled diabetic, uncontrolled diabetic, and nondiabetic. Patient demographic data, acute complications, and hospitalization outcomes were determined for each cohort.ResultsA total of 403,629 (15.7%) controlled diabetic patients and 19,421 (0.75%) uncontrolled diabetic patients underwent degenerative lumbar spine surgery from 2002 to 2011. Relative to nondiabetic patients, uncontrolled diabetic patients had significantly increased odds of cardiac complications, deep venous thrombosis, and postoperative shock; in addition, uncontrolled diabetic patients also had an increased mean length of stay (approximately, 2.5 d), greater costs (1.3-fold), and a greater risk of inpatient mortality (odds ratio=2.6, 95% confidence interval=1.5-4.8, P<0.0009). Controlled diabetic patients also had increased risk of acute complications and inpatient mortality when compared with nondiabetic patients, but not nearly to the same magnitude as uncontrolled diabetic patients.ConclusionSuboptimal glycemic control in diabetic patients undergoing degenerative lumbar spine surgery leads to increased risk of acute complications and poor outcomes. Patients with uncontrolled DM, or poor glucose control, may benefit from improving glycemic control prior to surgery.Level of evidence3.

Project description:ObjectiveTo demonstrate techniques of laparoscopic surgery while all elective procedures are suspended.DesignStepwise demonstration of key skills required when gardening with minimal access techniques.SettingGynecologist residence in self-isolation, Manchester, United Kingdom.InterventionsOwing to the coronavirus disease pandemic, elective operations are currently suspended in the United Kingdom. In addition, there have been concerns regarding the safety of laparoscopic surgery and risk of transmission of the coronavirus disease [1,2]. As a result, laparoscopic surgeons are at risk of skill deterioration, and it is uncertain whether this may have an impact on patient safety when lockdown measures are de-escalated.Combining gardening, one of the major pastimes during the lockdown period, and minimal access surgical skills, this video demonstrates the different ways minimal access surgery may be applied to horticulture.In the first described technique, what the author believes to be hedge bindweed (Calystegia sepium) was excised using a grasper and a tripolar cutting device (Fig. 1). For obvious reasons diathermy is not available within the home environment, but the retractable cutting blade was used to efficiently slice through the stems required for weed removal. The disadvantage of this technique is clearly that the unwanted species is likely to regrow in 12 months.In the second described technique, dandelions (genus Taraxacum) (Fig. 2), which are native to Eurasia and North America, were excised at the flowering stage, thereby effectively preventing asexual reproduction by apomixis. The technique similarly uses the retractable blade of the tripolar cutting device.The third technique demonstrates harvesting of an unknown species using a soil dissection technique. To facilitate complete removal of the plant and to reduce the risk of recurrence, the roots are carefully dissected out using blunt dissection. As with many techniques, patience is of paramount importance.Last, ensuring hydration of plants is crucial to their early stage of development. Laparoscopic watering techniques are usually simplified when an irrigation and suction device is employed. However, within a low-resource setting a slow process of "cup feeding" is required and requires meticulous dexterity (Fig. 3). Unfortunately, during this demonstration a common complication of a loss of instrument occurred, but the subject was luckily successfully hydrated.ConclusionWhile a lockdown remains in place, many gynecologists are not able to maintain their laparoscopic surgical skills. It is important to combine activities of daily living with minimal access training to maintain our physical and mental well-being. More research is clearly needed in the area of minimal access horticulture to expand this new and exciting subspecialty.

Dataset Information

Perioperative morbidity and complications in minimal access surgery techniques in obese patients with degenerative lumbar disease.

Publications

Perioperative morbidity and complications in minimal access surgery techniques in obese patients with degenerative lumbar disease.

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