In November, Bursnville, Minn.-based Inspired Spine established two Centers of Excellence that specialize in providing complex spine care for patients with a high body mass index.
The majority of patients operated on at the facility have BMIs over 40; an optimal BMI for an adult is no higher than 24.9, according to the CDC.
Patients with BMIs over 40 have historically faced challenges when seeking elective spine surgeries, with physicians recommending against the procedures, citing high risks.
While the new facilities are intended to provide safer operation settings for high-risk patients, some surgeons are skeptical.
Lali Sekhon, MD, a neuro and spine surgeon at Reno (Nev.) Orthopedic Center, told Becker's that not only does he have safety concerns about the facilities, he is also worried they might be sending the "wrong message" to patients.
Question: Are you skeptical of new "high BMI" facilities?
Dr. Lali Sekhon: By the book, we are supposed to proceed with caution on patients with BMI >40 for elective spine or joint surgery. The complication rate is higher and I think in the long run they do poorly because the underlying problem is not addressed. I am skeptical of "high BMI" facilities because it sends the wrong message. American healthcare is too focused on treatment and not prevention. If our patients lost weight, diabetes would disappear, less patients would need joint surgery, and quality of life would improve for them. There is no money in preventive medicine in this country, only for interventions. These facilities are fee-for-service and the patients are not having their root cause addressed. Every community has high BMI patients. They don't need centers for treatment of their spinal condition, they need grassroots preventive care with nutrition and exercise counseling and considerations for pharmacologic and bariatric intervention. We need to treat the root cause.
Q: Do you think these new facilities will improve patient safety and quality of life for those considered high-risk?
LS: Obese patients bleed more. They have more wound healing issues. More infections. More general complications. They have more reoperations. This occurs even in the most skilled hands. I've been a spine surgeon for 23 years and done more than 10,000 cases, but BMI >40 patients have more complications that I cannot control. It's operator independent.
Q: Do you think it is appropriate and safe to perform spine surgeries on patients with BMI-related comorbidities?
LS: The decision to operate on patients with high BMI for urgent/life-saving procedures is clear: Do what we can. For elective surgeries, it's less clear and there are moral and ethical issues as most of us operate on a fee-for-service model — we don't get paid for not operating as much as we do when we do. In my practice, I have a hard cut off of BMI 50 and [a cautious approach] for BMI >40. At the heart of it, we need to do what's right for the patient. A spine or joint surgery may give a few years of relief until the next level fails, but weight loss and nutritional/exercise counseling can last a lifetime. We are physicians first, not just technicians. This is not fat shaming. This is life counseling. These consultations can be done with empathy and compassion with assistance to get these patients into weight loss/bariatric programs. If the truck is rated for five tons and is carrying 10 tons, the answer is not to reinforce the shock absorbers — the answer is to reduce the load.