The Impact of Body Mass Index and Metabolic Syndrome on Perioperative Outcomes Following Cervical Laminoplasty

Study Design: Retrospective cohort study. Objectives: Obesity and metabolic syndrome have become a common comorbidity among patients undergoing spine surgery. This study aimed to evaluate 30-day postoperative outcomes following cervical laminoplasty, stratified by BMI categories and the presence of metabolic syndrome. Methods: This study utilized the 2007-2022 ACS-NSQIP database. Patients who underwent cervical laminoplasty were identified and categorized into six BMI groups, according to the World Health Organization guidelines, and based on the presence of metabolic syndrome. The primary outcome was the 30-day occurrence of at least one complication (excluding blood transfusions). Secondary outcomes included rates of complications, hospital length of stay, and total operative time. Results: A total of 2261 patients were analyzed, including 21 underweight, 510 normal-weight, 782 pre-obese, 565 class I obese, 249 class II obese, and 134 class III obese individuals. The cohort consisted of only 244 individuals with metabolic syndrome. Class II obesity (coefficient 23.585, 95% CI 10.815-36.355; P < 0.001) and class III obesity (coefficient 20.096, 95% CI 4.712-35.479; P = 0.011) were independently associated with longer operative times. Metabolic syndrome was an independent risk factor for deep incisional SSI (OR 3.25, 95% CI 1.07-9.80, P = 0.037), postoperative pneumonia (OR 4.17, 95% CI 1.63-10.63, P = 0.003), and prolonged hospitalization (OR 1.68, 95% CI 1.17-2.41, P = 0.005). Conclusions: Patients with metabolic syndrome face an increased risk of adverse outcomes after cervical laminoplasty. Implementing preoperative preventive interventions may help mitigate complications and associated costs in these patients. Furthermore, preoperative weight loss in class II-III obese patients may help decrease operative time and associated costs.