Table 1. Incidence of infection in the obese population undergoing spine surgery.

First author	Study design	Subjects (n)	Incidence of infection	Comments
De la Garza-Ramos6	Retrospective cohort study	732	BMI < 29.9: 3.78%; BMI > 30: 12.86% (p = 0.001)	Review of one- to three-level lumbar posterolateral fusions
Djurasovic45	Retrospective case series	270	BMI < 29.9: 0.6%; BMI > 30: 5.5% (p = 0.018)	Review of lumbar fusions for degenerative causes
Higgins35	Retrospective case series	801	BMI < 29.9: 1.5%; BMI 30–40: 4.2% (p = 0.03); BMI > 40: 15.0% (p < 0.001)	Study includes all instrumented cases at a single institution from all regions of the spine
Jiang27	Meta-analysis	93,183	OR BMI > 30 kg/m2: 2.33; 95% CI: 1.94–2.79	Evidence graded as moderate
Lim30	Retrospective multivariate analysis	3,353	OR BMI > 30 kg/m2: 1.63; 95% CI: 1.042–2.544 (p = 0.032)	Review of single-level lumbar fusion cases
Marquez-Lara29	Retrospective database review	24,196	BMI < 24.9: 0.7%; BMI > 25: 1.3% (p < 0.001)	Relative risk of infection increased as BMI increased (BMI > 40: RR: 3.8, 95% CI: 2.5–5.9; p = 0.001)
Mehta44	Retrospective case series	298	BMI < 29.9: 5.1%; BMI > 30: 12.3% (p = 0.025)	Skin-to-lamina distance and the thickness of the subcutaneous tissue were also associated with increased rates of infection
Soroceanu26	Retrospective database review	241	OR BMI > 30 kg/m2: 4.88 (p = 0.02)	Review of adult spinal deformity cases

Abbreviations: BMI, body mass index; CI, confidence interval; OR, odds ratio; RR, relative risk.