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Background: Bariatric surgery (BS) is an increasingly common treatment for morbid obesity that has the potential to effect bone and mineral metabolism. The effect of prior BS on spine surgery outcomes has not been well established. The aim of this study was to assess differences in complication rates following spinal surgery for patients with and without a history of BS.Methods: Retrospective analysis of the prospectively collected New York State Inpatient Database (NYSID) years 2004-2013. BS patients and morbidly obese patients (non-BS) were divided into cervical and thoracolumbar surgical groups and propensity score matched for age, gender, and invasiveness and complications compared.Results: One thousand nine hundred thirty-nine spine surgery patients with a history of BS were compared to 1625 non-BS spine surgery patients. The average time from bariatric surgery to spine surgery is 2.95 years. After propensity score matching, 740 BS patients were compared to 740 non-BS patients undergoing thoracolumbar surgery, with similar comorbidity rates. The overall complication rate for BS thoracolumbar patients was lower than non-BS (45.8% vs 58.1%, P < 0.001), with lower rates of device-related (6.1% vs 23.2%, P < 0.001), DVT (1.2% vs 2.7%, P = 0.039), and hematomas (1.5% vs 4.5%, P < 0.001). Neurologic complications were similar between BS patients and non-BS patients (2.3% vs 2.7%, P = 0.62). For patients undergoing cervical spine surgery, BS patients experienced lower rates of bowel issues, device-related, and overall complication than non-BS patients (P < 0.05).Conclusions: Bariatric surgery patients undergoing spine surgery experience lower overall complication rates than morbidly obese patients. This study warrants further investigation into these populations to mitigate risks associated with spine surgery for bariatric patients. [ABSTRACT FROM AUTHOR]

The efficacy of surgical intervention for central cord syndrome (CCS) is shown in the literature; however, it is unclear whether disparities in patient presentation and treatment exist between those who initially undergo operative treatment and those who delay operative treatment. In a population of CCS patients, assess disparities in presentation and treatment between those undergoing immediate surgery and those who delay operative treatment. Retrospective analysis of New York State Inpatient Database years 2004-2013. A total of 1,301 CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18). Time to surgery, length of stay (LOS). Patient-specific linkage codes allowed longitudinal tracking of inpatient stays within the study period. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), complications, and surgical factors, including Mirza invasiveness score, were compared between CCS patients that initially underwent surgery (Initial) and patients that delayed operative treatment (Delayed) using Chi-squared tests and independent samples t-tests as appropriate. Similar tests assessed differences in demographics and comorbidity burden between nonoperative patients and surgical crossover patients. Included: 1,301 CCS patients (62±16 yrs, 27% female). Follow-up rate was 67.3%; mean follow-up time was 515±707 days. By level of CCS injury, 61.0% of patients were injured between C1 and C4, 59.2% between C5-C7, 1.0% between T1-T6, and 0.6% between T7-T12. Overall, 800 (61%) patients underwent surgical treatment (procedural breakdown: 80% fusion, 59% decompression, including 38% discectomy and 23% other decompression of the spinal canal). Of the surgical patients, 621 (78%) had surgery at first recorded hospital visit, while 179 (22%) experienced a delay before surgical treatment. For patients that delayed treatment, mean time to surgery was 203±358 days. Initial and Delayed patients did not differ in sex (p=0.109) or CCI (p=0.894), though Initial patients were younger than Delayed (60±15 yrs vs 63±13, p=0.016) and had lower rates of diabetes and valvular disease (both p<0.04). Initial patients underwent more invasive procedures than Delayed (5.1±2.6 vs 4.3±3.2, p=0.003), including higher rates of fusion (84% vs 71%, p<0.001), but not decompression: overall (59% vs 60%, p=0.816), discectomy (39% vs 35%, p=0.306), other canal decompression (22% vs 27%, p=0.175). LOS was longer for Initial patients (16±20 days vs 7±10, p<0.001), but complication rates did not differ (all p>0.05). Patients who delayed operative treatment did not differ from nonop patients in age (63±13 vs 63±17, p=0.802) or CCI (1.04±1.49 vs 1.06±1.49, p=0.923); however, Delayed patients had higher rates of diabetes (26% vs 18%, p=0.037), neurologic disorders (7% vs 1%, p<0.001), and valvular disease (6% vs 2%, p=0.026) than patients that remained nonoperative. Although patients managed with initial surgical treatment of CCS had longer hospital stays and were treated with more invasive procedures, perioperative complications did not differ. Twenty-two percent of CCS patients crossed over from nonoperative to operative treatment, with a mean time to crossover of 203 days. Patients who crossed over to operative care were more comorbid than patients who remained nonoperative, indicating comorbidity burden may play a role in the decision to operate. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]