Friday, September 28, 2018 3:00 PM–4:00 PM abstracts: the gravity of obesity: 227. Bariatric surgery population at significantly increased risk of spinal disorders and surgical intervention compared to morbidly obese patients

Abstract

BACKGROUND CONTEXT Obesity is associated with acceleration of musculoskeletal degenerative diseases and functional impairment secondary to spinal disorders. Bariatric surgery is an increasingly common treatment for severe obesity, but can affect bone and mineral metabolism. The effect of bariatric surgery on degenerative spinal disorders is yet to be fully described. PURPOSE To analyze changes in bariatric patients risk for spinal degenerative diseases and spinal surgery. STUDY DESIGN/SETTING Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years (2004–2013). PATIENT SAMPLE A total of 8,176 bariatric patients and 146,252 morbidly obese patients (without bariatric surgery). OUTCOME MEASURES Incidence of spinal diagnoses and spinal procedures. METHODS NYSID collects over 100 clinical and nonclinical data elements on over 2 million hospital admissions per year: diagnoses, procedures, patient demographics (eg sex, age, race), charges, length of stay, and hospital characteristics (size, location, teaching status). Patient linkage codes allow identification of readmissions within the time-frame analyzed. The incidence of degenerative spinal diagnoses and spinal surgery for simple fusions (one or two levels, one approach), complex fusions (three or more levels, or multiple approaches), or decompression-only procedures for spinal disorders was queried using ICD-9 codes for morbidly obese patients (ICD-9 278.01) with and without a history of bariatric surgery. RESULTS A total of 18,176 patients were identified in the NYSID database with a history of bariatric surgery and 146,252 patients were identified as morbidly obese without a history of bariatric surgery. Bariatric surgery patients have a significantly higher rate of spinal diagnoses than morbidly obese patients without bariatric surgery (19.3% vs. 8.1%, P CONCLUSIONS Morbidly obese patients who have undergone bariatric surgery have a dramatically increased incidence of spinal diagnoses and procedures, which translates into elevated rates of surgical intervention as compared to morbidly obese patients without bariatric surgery and this relationship persists when controlling for age, gender, and CCI. Further study is necessary to determine if there is a pathophysiological mechanism underlying this higher risk of spinal disease and intervention in bariatric patients.