Operative Difficulties and Post-Surgical Outcomes in “Super Morbidly Obese” (Class 4+) Patients

Study Design Retrospective Cohort Study. Objective Obesity rates have risen over recent decades, with many affected individuals experiencing degenerative spine conditions. A parallel increase in spine surgeries has raised questions about how to best optimize care in obese patients. Those with extremely high BMI (>50), classified as “Super Morbidly Obese (SMO)”, may face higher risks of poor surgical outcomes. To better understand the challenges in treating this population, we compared complications, and operative characteristics between morbidly obese (MO), and SMO. Methods A single-institution retrospective review was conducted on patients with a BMI over 40 who underwent a neurosurgical procedure from 2017 to 2023. Inclusion criteria were (1) patient age >17 years, (2) BMI >40, and (3) surgical interventions performed by a member of the department of neurological surgery. Demographic, clinical, surgical, and post-operative follow-up were analyzed. Results Patients were split into SMO (BMI 50+) and MO (BMI 40-50) groups. SMO received more intra-operative imaging radiation ( P = 0.0169), experienced longer hospital stays ( P < 0.0005) and experienced more post-operative complications than MO patients ( P = 0.008). SMO patients experienced more complications when discharged home than their MO counterparts ( P = 0.0002, RR = 12.2 2.7-53.4). Conclusion Risk in SMO spine surgery can be reduced through weight loss, modified surgical approaches, and better discharge planning. Regardless of comorbidities, SMO patients discharged home face higher complication rates than MO patients and may benefit from early discussions about skilled nursing placement. Larger studies are needed to better assess surgical management and outcomes in this population.