Prior bariatric surgery is associated with lower complications, in-hospital mortality, and healthcare utilization after elective spine fusion surgery

Background Grade 3 obesity could potentially increase postoperative complications after spinal fusion surgery. However, the relationship between prior bariatric surgery (BS) and postoperative complications after spinal fusion surgery is not well-established. Setting Inpatient hospital admissions from the Nationwide Inpatient Sample. Methods Patients with a primary procedure of spinal fusion surgery discharged between 2006 and 2014 were identified. In-hospital outcomes included postoperative complications, mortality, cost, and length of stay were compared between patients with prior BS and grade 3 obesity. Results A total of 3,132,192 patients who underwent elective spinal fusion surgery were identified. There were 33,936 (1.1%) patients with a diagnosis of prior BS. The prevalence of prior BS increased significantly from .1% in 2006 to 1.5% in 2014. Compared with patients with grade 3 obesity, patients with prior BS were younger, more likely to be female, had less co-morbidities, and higher proportion of cervical surgery. Multivariable analysis indicated that patients with prior BS had lower risk of overall complications (odds ratio [OR]: .44; 95% confidence interval [CI]: .38–.49), neurologic (OR: .55; 95%CI: .35–.84), respiratory (OR: .30; 95%CI: .23–.37), cardiac (OR: .38; 95%CI: .24–.60), gastrointestinal (OR: .61; 95%CI: .44–.84), urinary and renal (OR: .34; 95%CI: .26–.44), venous thromboembolism (OR: .35; 95%CI: .19–.63), wound-related complications (OR: .67; 95%CI: .53–.85), and in-hospital mortality (OR: .12; 95%CI: .02–.88). Prior BS was also related to 13% shorter length of stay and 2% lower cost. Conclusions Among patients undergoing spinal fusion surgery, prior BS is associated with lower complications, in-hospital mortality, and healthcare utilization. BS might mitigate risk of worse outcomes associated with grade 3 obesity after spine fusion surgery.