Obesity in Pediatric Orthopaedics
Obesity in Pediatric Orthopaedics
Obesity also may have a negative effect on scoliosis treatment. Obese patients are more difficult to treat effectively with bracing, which may discourage many physicians (including the author) from attempting bracing. Obesity also affects surgical management. Hardesty, et al. reviewed records of 181 healthy-weight and 55 obese patients who had undergone posterior spinal surgery for scoliosis. Obese patients required on average 31min longer operative time and had 147mL higher mean blood loss. Slight differences in postoperative correction were noted but were clinically insignificant. They noted neither an increase in rate of major intraoperative or postoperative complications nor an increased rate of infection with a minimum of 2 yr of follow-up. A systemic review of factors contributing to surgical site infections after scoliosis surgery determined that there was grade C evidence that obesity increases risk of infection based on the findings of two of three level III studies. Taken together, these studies indicate that obese patients are (1) less likely to have successful nonoperative treatment, (2) may have a slightly increased rate of infection, and (3) more likely to require longer surgery, with more blood loss. What has not been discussed well in the literature is whether obese patients with scoliosis are more or less concerned with their appearance than nonobese patients and whether they are less likely to receive operative treatment. The author does not consider obesity a contraindication to operative treatment of scoliosis, but does counsel patients regarding the risks of increased blood loss and possible increased risk of infection. In addition, the author is more likely to recommend observation for obese patients with wellbalanced double major curves and/or patients with curves that would require fusion to the 4 or 5 lumbar vertebrae.
Scoliosis
Obesity also may have a negative effect on scoliosis treatment. Obese patients are more difficult to treat effectively with bracing, which may discourage many physicians (including the author) from attempting bracing. Obesity also affects surgical management. Hardesty, et al. reviewed records of 181 healthy-weight and 55 obese patients who had undergone posterior spinal surgery for scoliosis. Obese patients required on average 31min longer operative time and had 147mL higher mean blood loss. Slight differences in postoperative correction were noted but were clinically insignificant. They noted neither an increase in rate of major intraoperative or postoperative complications nor an increased rate of infection with a minimum of 2 yr of follow-up. A systemic review of factors contributing to surgical site infections after scoliosis surgery determined that there was grade C evidence that obesity increases risk of infection based on the findings of two of three level III studies. Taken together, these studies indicate that obese patients are (1) less likely to have successful nonoperative treatment, (2) may have a slightly increased rate of infection, and (3) more likely to require longer surgery, with more blood loss. What has not been discussed well in the literature is whether obese patients with scoliosis are more or less concerned with their appearance than nonobese patients and whether they are less likely to receive operative treatment. The author does not consider obesity a contraindication to operative treatment of scoliosis, but does counsel patients regarding the risks of increased blood loss and possible increased risk of infection. In addition, the author is more likely to recommend observation for obese patients with wellbalanced double major curves and/or patients with curves that would require fusion to the 4 or 5 lumbar vertebrae.
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