105 - Severe Obesity Is an Independent Risk Factor of Early Readmission and Non-Home Discharge After Cervical Disc Replacement

Saturday, June 3, 2023

10:48 AM – 10:50 AM

Location: Salons 13-15

Presenting Author (Person doing the Podium Present(s)

TS

Tejas Subramanian, BS

Hospital for Special Surgery, United States

Co-Author(s)

DS

Daniel Shinn, BE

Medical Student
hospital for special surgery, United States
PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States
IA

Izzet Akosman, BS

Hospital for Special Surgery, United States
TA

Troy Amen, MD, MBA

Hospital for Special Surgery, United States
OM

Omri Maayan, BS

Hospital for Special Surgery, United States
KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States
EZ

Eric Zhao, BS

Hospital for Special Surgery, United States
Junho Song, BS

Medical Student Research Fellow
Hospital for Special Surgery
New York, New York, United States
SD

Sidhant Dalal, BS

hospital for special surgery, United States
JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States
ES

Evan Sheha, MD

Hospital for Special Surgery, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States
SQ

Sheeraz A. Qureshi, MD, MBA

Attending Surgeon
Hospital for Special Surgery
York, New York, United States

Submitter(s)

ES

Evan Sheha, MD

Hospital for Special Surgery, United States

Disclosure(s):

Tejas Subramanian, BS: No financial relationships to disclose

Omri Maayan, BS: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction: Despite growing interest in cervical disc replacement (CDR) for conditions such as cervical radiculopathy, limited data exists describing the impact of obesity on early outcomes complications. As the obesity population continues to increase, this topic becomes especially salient.

Aims/

Objectives: The goal of this study was to compare demographics, perioperative variables, and complication rates between obese and non-obese patients following CDR.

Methods: The 2005-2020 ACS-NSQIP datasets were queried for patients who underwent primary 1-/2-level CDR using CPT codes 22856 and 22858. Exclusion criteria included revisions, infection, malignancy, emergency, and BMI < 18.5. Patients with missing information were excluded. Patients were divided into: Non-Obese (BMI:18.5-29.9), Obese Class-1 (BMI:30-34.9), Obese Class-I/III (BMI≥35). Morbidity was any complication within 30 days postoperatively. Rates of 30-day readmission, reoperation, morbidity, individual complications, length of stay, frequency of non-home discharge disposition were collected. Cohorts were compared via Fisher’s exact test for categorical variables. ANOVA and Kruskal-Wallis tests were used for normally/non-normally distributed continuous variables, respectively. Post-hoc, pairwise analyses were included if there was a significant difference between the three cohorts.

Results: A total of 5397 patients were included. 3130 were non-obese, 1348 were Obese-class-I, and 919 were Obese-Class-II/III. Both Class-II/III and Class-I significantly more black patients than the non-obese group (11.1% vs 9.1% vs 6%, respectively; p< 0.001) but also were older (47±10.1 vs 47±10.2 vs 46.2±11; p=0.004). There were more females in Class-II/III (55.6%) compared to both Class-I (55.6% vs 44.1%; p< 0.05) and non-obese (55.6% vs 47.6%; p< 0.05). There were more 2-level CDRs performed in the Class-II/III cohort compared to the non-obese group (25.7% vs 21.5%, respectively; p< 0.05). Class-II/III had more non-home discharges than Class-I and non-obese (2.1% vs 0.5% vs 0.7%, respectively; p< 0.001). Readmission rates differed as well (non-obese: 0.5%, Class-I: 1.1%, Class-II/III: 2.1%; p< 0.001) with pairwise significance between class-II/II and non-obese. Neither 30-day reoperation (non-obese: 0.4%, Class-I: 0.5%, Class-II/III: 1%; p=0.094) nor morbidity (non-obese: 0.8%, Class-I: 1.3%, Class-II/III: 1.4%; p=0.156) demonstrated significance.

Conclusions: Although obese class-II/III patients experienced greater rates of 30-day readmission and non-home discharge, there was no difference in reoperation rates or morbidity, suggesting 1- and 2-level CDR can continue to be safely used independent of obesity status.