Optimizing Care for High BMI Spine Surgery Patients

Obesity rates have nearly tripled since 1975, representing a growing worldwide public health crisis. Consequently, orthopedic practices are encountering increasing numbers of overweight patients seeking spine surgery. Many of these candidates are categorized as obese, presenting with high body mass indexes (BMIs) of 30 or greater. Historically, some facilities turned these patients away due to liability or equipment concerns. However, the trend is shifting towards accommodation. As ambulatory surgery techniques and experience have advanced, more high-BMI spine surgery patients can undergo safe, effective outpatient procedures.

Factors to Consider

A study by the National Library of Medicine asserts that obesity poses innate risks during spine procedures, including higher wound infection rates, greater blood loss, longer operations, increased incidences of deep vein thrombosis, and more repeat laminectomies.

The density of high-BMI patients can also complicate surgical planning; excess body mass can distort intra-operative images and obscure vertebrae, discs, ligaments, and nerves. Furthermore, spine surgeons may struggle to access surgical sites on high-BMI patients. Excess fat deposits can physically block the working surgical corridor. Attempting to retract or maneuver around this tissue risks damaging blood vessels or nerves. Once in surgery, high-BMI patients may also prove complex for anesthesia teams to manage safely.

Lastly, caring for high-BMI spine patients requires evaluating numerous factors beyond their weight. Obesity is heavily associated with comorbid conditions like Type 2 diabetes, hypertension, osteoarthritis, cardiovascular disease, and obstructive sleep apnea. Uncontrolled, these metabolic and vascular conditions may heighten surgical risks and lead to post-operative complications.

Treating this unique patient population often introduces heightened risks, complications, and challenges throughout the spectrum of spine care. Fortunately, these obstacles do not necessarily prohibit high-BMI spine surgery candidates from receiving the care they need.

Below are several keys to optimizing outcomes for these patients.

1. Customized Care Plans

Beyond lifts and wider beds, caring for high BMI spine surgery patients may require customized care plans to address their unique risks. Preoperatively, it might be helpful for orthopedic clinics to identify medical factors beyond spinal issues that a high BMI may complicate, such as diabetes, respiratory conditions, and heart abnormalities. If reasonable, a patient’s weight and associated conditions may need to be optimized through treatment for several weeks prior to spine procedures.

“Because obesity is a modifiable risk factor, enrolling patients in a nonsurgical weight loss plan could address this complex complication profile,” one study suggests.

Planning anesthesia techniques in advance can also enhance patient safety. “Ramped” positioning of the patient, video laryngoscopes, and bilevel positive airway pressure may improve airway access during the intubation and extubation despite additional neck tissue.

Multidisciplinary teams, which typically make up the core of many successful ambulatory surgical centers (ASCs), are especially effective at delivering comprehensive care tailored to individual patient needs. The combined expertise of a team of specialists may result in shorter hospital stays, faster recovery times, and higher patient satisfaction rates.

2. Up-To-Date Surgical Techniques

Advances in minimally invasive spine surgery, many of which have been pioneered in ASC settings, allow for shorter procedures with less blood loss and quicker patient recovery – clear advantages for high BMI patients.

For example, surgeons can now use CT-guided robots with 3D navigation to precisely position spine implants without the added disadvantage of awkward angles and obstructing layers of excess tissue. Additionally, minimally invasive surgical techniques can utilize advanced tubular retractors with microscopes to access the spine through small skin openings, avoiding cutting of excess tissue that may later become infected.

In ASCs, short outpatient procedures also mean less anesthesia exposure, potentially reducing cardiopulmonary complications. Finally, modern intraoperative CT scans and computer-assisted navigation offer enhanced spine imaging, making pre-operative planning for high-BMI patients more precise.

3. Patient Education & Setting Expectations

Spine surgeons have a responsibility to guide high BMI patients through post-op care. Beyond standard risks, obesity may pose additional threats after surgery, including infection, delayed healing, fluid buildup, and other issues.

Thorough patient education should cover:

Realistic recovery timeframes – high BMI patients may require extended healing periods and rehabilitation.
Potential complication risks – infection, thromboembolism, etc.
Post-op diet and nutrition – nutritional needs, protein requirements for wound healing.
Home care protocols – incision care, activity restrictions, and setting realistic milestones around driving, work duties, and household chores to maximize recovery.
Warning signs to monitor – wound drainage, fever, pain, or leg weakness.

Most importantly, respect and compassion should frame all interactions. Some high-BMI spine surgery patients feel shame and frustration regarding weight struggles. Spine surgery hinges upon trust – a successful procedure means little without complete patient cooperation and understanding of post-op care.