Complication Frequency and Timing in Patients with Morbid Obesity Undergoing Anterior Skull Base Surgery

Objective: This study analyzes quantifiable scalar aspects of morbidly obese patients undergoing anterior skull base surgeries. Our analysis investigates the timing of intraoperative and postoperative complications of patients with a BMI ≥ 40 kg/m². Our study also compares different types of complications that morbidly obese patient experience following anterior skull base surgery. We also investigate the difference in timing of perioperative complications for morbidly obese patients (BMI ≥ 40 kg/m²) versus nonmorbidly obese patients (BMI < 40 kg/m²).

Study Design: Retrospective database review.

Methods: The 2005–2015 National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent anterior skull base surgery. Propensity score matching (PSM) was used to homogenize the study population. Chi-squared analysis and independent samples t-test were used to determine the independent effect of covariates on postoperative complication rates, probability of complication, timing of readmission, and likelihood of reoperation.

Results: A total of 4,053 patients were identified in the NSQIP database who underwent anterior skull base surgery. Patients who had BMI ≥ 40 kg/m² (N = 318) were identified as morbidly obese and were compared with non-morbid obese patients (N = 3735). Independent samples t-test revealed that morbidly obese patients had a greater number of cardiac arrest events requiring cardiopulmonary resuscitation (p = 0.19), wound disruption complications (p = 0.035), anemia requiring transfusions (p = 0.035), and progressive renal insufficiency (p = 0.041). Independent samples t-test also revealed that only the complication of renal insufficiency (p = 0.028) demonstrated significantly different complication timing when occurring morbidly obese patients compared with non-morbid obese patients. Estimated probability of morbidity (p = 0.09) and estimated probability of mortality (p = 0.09) were also increased in morbidly obese patients. In addition, the rates of readmission (p = 0.401) and reoperation (p = 0.506) were not significantly different when comparing morbidly obese patients to nonmorbidly obese patients.

Conclusion: This analysis underscores differences in estimated mortality probability, estimated mortality probability, and rates of postoperative complications in morbidly obese patients undergoing anterior skull base procedures. Our analysis did not demonstrate a difference in readmission rates and reoperation rates when comparing patients based on morbid obesity status.

Publication History

Article published online:
12 February 2021