Morbid obesity is associated with outcomes in patients undergoing vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures: a nationwide inpatient sample analysis

Background Osteoporotic vertebral compression fractures (OVCF) significantly affect older adults, leading to considerable morbidity and healthcare costs. Despite the known health risks of morbid obesity, its impact on surgical outcomes of OVCF remains underexplored. This study examines the influence of morbid obesity on the clinical outcomes of patients undergoing vertebral augmentation procedures, specifically vertebroplasty (VP) or kyphoplasty (KP). Methods We analyzed data from the National Inpatient Sample (NIS) for hospitalized patients aged 60 years or older undergoing VP or KP for OVCF from 2005 to 2020. Morbid obesity was defined as a body mass index (BMI) above 40 kg/m(2). The primary outcomes assessed in-hospital mortality, discharge destinations, hospital stays, costs, and complications. Logistic and linear regressions adjusted for confounders were used to determine the impact of morbid obesity on these outcomes. Results The analysis included 4734 patients. Patients with morbid obesity accounted for 30.1% of the study sample. After adjustment for relevant demographic and clinical confounders, morbid obesity was significantly associated with increased risks of unfavorable discharge (adjusted OR (aOR): 1.24, 95% confidence interval (CI): 1.08-1.42, P=0.002) and overall complication (aOR=1.15, 95% CI 1.01 to 1.30, P=0.041), including venous thromboembolism (VTE; aOR=1.57, 95% CI 1.07 to 2.30, P=0.020, P=0.003), urinary tract infection (aOR=1.35, 95% CI 1.14 to 1.60, P=0.001), and acute kidney injury (AKI; aOR: 1.47, 95% CI 1.21 to 1.78, P<0.001). Conclusions Morbid obesity is associated with an increased risk of adverse short-term outcomes in patients undergoing VP or KP for OVCF, including unfavorable discharge and specific complications. These findings contribute insights to preoperative risk stratification and encourage clinicians to be more vigilant in managing this high-risk population. Further prospective research is still needed to confirm these associations and develop effective interventions.