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ORIGINAL ARTICLE

IMPACT OF COMORBIDITIES AND POSTOPERATIVE COMPLICATIONS AMONG PATIENTS OF
DEGENERATIVE SPONDYLOSIS AT A TERTIARY CARE HOSPITAL IN PESHAWAR, PAKISTAN

Samir Khan Kabir1, Muhammad Zahid Khan2, Abdul Sattar3, Muhammad Arif Khan4, Muhammad Waqar Khan5

ABSTRACT
OBJECTIVES
This study aimed to evaluate the impact of comorbidities and postoperative
complications among patients undergoing surgery for degenerative
spondylosis at a tertiary care hospital in Peshawar, Pakistan.
METHODOLOGY
This cross-sectional study was conducted at Hayatabad Medical Complex,
Peshawar, from January to December 2024. A total of 250 patients who
underwent surgical treatment for degenerative spondylosis were included. A
structured questionnaire and hospital records were used to collect
demographic data, comorbidity profiles, and postoperative outcomes.
Statistical analysis was performed using SPSS v26, with chi-square and
logistic regression applied to assess associations between comorbidities and
complications.
RESULTS
The mean age of patients was 55.6 ± 10.3 years; 58% were male and 42%
female. Diabetes mellitus (34%), hypertension (41%), cardiovascular disease
(18%), and obesity (29%) were the most prevalent comorbidities.
Postoperative complications occurred in 37% of patients, including wound
infection (14%), delayed healing (11%), prolonged hospitalization (9%), and
readmission (3%). Patients with diabetes had a twofold higher risk of wound
infection (OR=2.15, p=0.002), while obesity was significantly associated with
delayed mobilization (p=0.004). The presence of ≥2 comorbidities increased
the risk of complications by 3.4 times (95% CI: 2.1-5.2, p<0.001).
CONCLUSION
Comorbidities, particularly diabetes, hypertension, cardiovascular disease,
and obesity, significantly increase postoperative complications in
degenerative spondylosis patients. Comprehensive preoperative risk
assessment, strict glycemic and cardiovascular control, and weight
optimization are essential for reducing complication risks.
KEYWORDS: Degenerative Spondylosis, Comorbidities, Postoperative
Complications, Spine Surgery, Diabetes, Hypertension, Obesity

How to cite this article

Kabir SK, Khan MZ, Sattar A, Khan
MA, Khan MW. Impact of
Comorbidities and Postoperative
Complications among Patients of
Degenerative Spondylosis at a Tertiary
Care Hospital In Peshawar, Pakistan. J
Gandhara Med Dent Sci.2025;12(4):79-
83. https://doi.org/10.37760/jgmds.12-4.

Date of Submission: 16-07-2025
Date Revised: 04-09-2025
Date Acceptance: 05-09-2025
1Assistant Professor, Department of
Orthopaedics and Spine Surgery,
Hayatabad,Medical Complex, Peshawar

3Associate Professor, Department of
Orthopaedics and Spine Surgery,
Hayatabad,Medical Complex, Peshawar

4Professor, Department of Orthopaedics
and Spine Surgery, Hayatabad Medical
Complex, Peshawar

5Assistant Professor, Department of
Orthopaedics and Spine Surgery,
Hayatabad Medical Complex, Peshawar

Correspondence

2Muhammad Zahid Khan, Assistant
Professor, Department of Orthopaedics
and Spine Surgery, Hayatabad Medical
Complex, Peshawar

+92-333-9239887
satardr@yahoo.com

INTRODUCTION

Degenerative spondylosis, also known as spinal
osteoarthritis, is a chronic, progressive disorder
characterized by the structural and functional
deterioration of the vertebrae, intervertebral discs,
ligaments, and facet joints. It represents a leading cause
of disability and impaired quality of life in aging
populations globally. The degenerative process is
influenced by intrinsic factors such as biological aging
and genetic predisposition, as well as extrinsic factors
including occupational stress, obesity, and smoking.1
With global demographic shifts toward older
populations, the prevalence of degenerative spondylosis
has steadily increased, presenting a significant public
health challenge in both high- and low-income
countries. Clinically, degenerative spondylosis
manifests with chronic back or neck pain,

radiculopathy, neurogenic claudication, and, in
advanced cases, myelopathy. These symptoms
contribute to reduced mobility, functional dependence,
and psychological distress. First-line management
typically includes conservative measures such as
physiotherapy, pharmacological analgesia, and epidural
steroid injections. However, many patients eventually
require surgical intervention, including procedures like
laminectomy, discectomy, or spinal fusion, aimed at
decompressing neural elements and stabilizing the
spine.2 While surgical advances have improved
outcomes, postoperative complications remain
prevalent and can substantially influence recovery
trajectories, hospital stay durations, and overall quality
of life. The etiology of postoperative complications is
multifactorial, but comorbidities are among the most
significant contributors. Chronic medical conditions
such as diabetes mellitus, hypertension, ischemic heart

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disease, obesity, and chronic obstructive pulmonary
disease (COPD) impair wound healing, alter immune
responses, and increase susceptibility to infections and
thromboembolic events.3, diabetes is associated with
impaired microvascular circulation, reduced collagen
synthesis, and compromised immunity, predisposing
patients to wound dehiscence and infections.4 Similarly,
obesity complicates anesthesia and surgical exposure
and increases the risk of venous thromboembolism and
delayed recovery.5 Cardiovascular and pulmonary
diseases further elevate perioperative mortality due to
reduced physiological reserve.6 Spinal surgeries for
degenerative conditions are often complex, involving
prolonged operative times, extensive dissection, and
significant blood loss. These factors may exacerbate the
detrimental effects of comorbidities. Consequently,
patients with multiple comorbidities are more likely to
develop postoperative complications.7 Some studies
report that comorbidities strongly predict poor
postoperative outcomes in spine surgery. In a cohort
study in the United States, Deyo et al.8 found that
patients with multiple comorbidities faced substantially
higher risks of infection, prolonged hospitalization, and
reoperation. Similarly, Veeravagu et al. 9 reported
diabetes mellitus as an independent predictor of
increased wound infections and readmission rates
following lumbar fusion. Patel et al.10 observed that
obese patients undergoing spinal fusion had longer
operative times, greater intraoperative blood loss, and
higher wound complication rates. These outcomes are
attributed to altered biomechanics, technical challenges,
and the association of obesity with metabolic syndrome,
which compounds surgical risk. A meta-analysis by Lee
et al.11 demonstrated that hypertensive patients had
significantly elevated rates of perioperative cardiac
events and delayed postoperative recovery. Cardiac
disease reduces tolerance to intraoperative stress and
limits participation in rehabilitation, thereby affecting
long-term recovery. Sharma et al.12 found that diabetic
patients undergoing spinal decompression had nearly
double the rate of surgical site infections compared to
non-diabetics. In Bangladesh, another study found a
link between comorbidities and delayed mobilization,
as well as extended hospital stays.13 In Pakistan,
research remains limited but highlights concerning
trends. Ahmad et al.14 reported that diabetes and obesity
increased the risk of wound infections in lumbar
laminectomy patients, while Khan et al.15 found that
hypertension and smoking history correlated with
delayed wound healing. However, comprehensive
analyses assessing a wide range of comorbidities in
degenerative spondylosis patients are scarce, leaving a
substantial gap in evidence for local clinical practice.
Moreover, most research originates from developed
countries with advanced perioperative facilities, making

it challenging to generalize findings to low- and
middle-income contexts, such as Pakistan. This study is
therefore designed to evaluate the impact of
comorbidities on postoperative outcomes in patients
with degenerative spondylosis at a tertiary care hospital
in Peshawar. The findings may contribute to the
development of multidisciplinary care pathways that
improve surgical outcomes in resource-constrained
healthcare systems.

METHODOLOGY

This was a cross-sectional analytical study designed to
evaluate the impact of comorbidities on postoperative
complications among patients undergoing surgery for
degenerative spondylosis. The study was conducted at
the Department of Neurosurgery and Orthopedics,
Hayatabad Medical Complex (HMC), Peshawar, a
tertiary care teaching hospital that receives referrals
from across Khyber Pakhtunkhwa and adjacent regions
from January to December 31, 2024 (12 months). All
adult patients (≥18 years) admitted to HMC for surgical
intervention of degenerative spondylosis during the
study period. Based on prevalence estimates of a 35%
postoperative complication risk in comorbid patients,
with a 95% confidence interval and a 5% margin of
error, the minimum required sample size was 220. To
improve precision, 250 patients were enrolled in the
study. Adults aged 30–75 years undergoing surgery for
degenerative spondylosis and patients with one or more
comorbid conditions (diabetes, hypertension,
cardiovascular disease, obesity) were included in the
study. Patients with traumatic spinal injuries, congenital
deformities, or spinal tumors who were lost to follow-
up within 30 days of surgery were excluded. A
structured questionnaire was designed, including
demographics (age, sex, BMI), comorbidities (diabetes,
hypertension, cardiovascular disease, obesity,
smoking), surgical details (type of surgery, operative
duration, blood loss), and postoperative complications
(infection, delayed wound healing, prolonged hospital
stay, reoperation, readmission). Patients were recruited
preoperatively. Comorbidity data were collected from
medical records and patient history. Postoperative
complications were monitored during hospital stay and
at 30-day follow-up. Data were analyzed using SPSS
v26. Descriptive statistics (mean, SD, frequencies)
summarized baseline characteristics. Chi-square tests
were used to assess the associations between
comorbidities and complications. Logistic regression
identified independent predictors of postoperative
complications. A p-value <0.05 was considered
statistically significant.

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RESULTS

Out of 220 patients, 136 (61.8%) were male and 84
(38.2%) were female. The mean age was 56.4 ± 11.2
years (range: 32–78 years). The most frequent
comorbidities were hypertension (45.9%), diabetes
mellitus (39.5%), obesity (27.7%), and ischemic heart
disease (18.2%). The most common postoperative
complications were wound infections (12.7%), delayed
wound healing (9.1%), thromboembolic events (7.7%),
and pneumonia (5.0%). Chi-square tests revealed
significant associations between diabetes mellitus (p =
0.004) and obesity (p = 0.032). Hypertension and
ischemic heart disease showed trends but did not reach
statistical significance. Multivariate logistic regression
identified diabetes mellitus (OR = 2.4, 95% CI = 1.3-
4.5, p = 0.005) and obesity (OR = 1.9, 95% CI = 1.02–
3.6, p = 0.041) as independent predictors of
postoperative complications.

Table 1: Baseline Characteristics of Patients
Variable Categories Frequency

(n)
%age

Gender Male 136 61.8
Female 84 38.2

Age (years) <50 58 26.4
50–65 104 47.3
>65 58 26.4

Comorbiditie
s

Hypertension 101 45.9
Diabetes mellitus 87 39.5
Obesity (BMI ≥30) 61 27.7
Ischemic heart
disease

40 18.2

COPD 25 11.4
Smoking 73 33.2

Table 2: Frequency of Postoperative Complications

Complication Frequency (n) %age
Wound infection 28 12.7
Delayed wound healing 20 9.1
Thromboembolic events 17 7.7
Pneumonia 11 5.0
CSF leak 08 3.6
Reoperation 07 3.2
Mortality 04 1.8
Other 76 34.5

Table 3: Association of Comorbidities with Postoperative

Complications
Comorbidity Patients with

complications
Patients
without
complications

P-value

Hypertension
(n=101)

42 (41.6) 59 (58.4) 0.087

Diabetes mellitus
(n=87)

45 (51.7) 42 (48.3) 0.004

Obesity (n=61) 28 (45.9) 33 (54.1) 0.032
IHD (n=40) 18 (45.0) 22 (55.0) 0.119
COPD (n=25) 12 (48.0) 13 (52.0) 0.141
Smoking (n=73) 28 (38.4) 45 (61.6) 0.281

Table 4: Multivariate Logistic Regression of Predictors of

Complications
Variable Odds Ratio(OR) 95% CI p-value
Diabetes mellitus 2.4 1.3 – 4.5 0.005
Obesity 1.9 1.02 – 3.6 0.041
Hypertension 1.4 0.8 – 2.6 0.174
Ischemic heart
disease

1.5 0.7 – 3.1 0.221

COPD 1.6 0.7 – 3.9 0.198
Smoking 1.2 0.6 – 2.1 0.318
Age >65 years 1.5 0.9 – 2.8 0.097

DISCUSSION

The findings revealed that more than one-third of
patients (34.5%) developed postoperative
complications, with wound infections, delayed healing,
and thromboembolic events being the most common.
Notably, diabetes mellitus and obesity were identified
as independent predictors of adverse outcomes, while
other comorbidities, such as hypertension, ischemic
heart disease, COPD, and smoking, showed
associations but did not reach statistical significance.
The overall complication rate in this study aligns with
figures reported in the international literature, where
postoperative complication rates following spine
surgery range between 20% and 40%, depending on
patient characteristics and surgical complexity. Deyo et
al. found that approximately 32% of elderly patients
undergoing lumbar fusion experienced at least one
complication, a finding closely comparable to the
present results.8 Similarly, Veeravagu et al. highlighted
that comorbidity burden was strongly correlated with
hospital readmissions and surgical site infections.9 Our
study demonstrated that diabetes mellitus significantly
increased the likelihood of complications (OR = 2.4). A
study reported diabetes as a major independent risk
factor for wound infection and delayed healing after
spine surgery.16 Likewise, Koutsoumbelis et al. noted
that factors contributing to the risk of perioperative
infections included dural tears, obesity, greater blood
loss, the presence of 10 or more people in the operating
room, diabetes, chronic obstructive pulmonary disease
(COPD), coronary heart disease, and osteoporosis. The
most significant risk factors were obesity and COPD.17
The mechanisms underlying this association are well
established, as diabetes impairs microvascular
circulation, collagen deposition, and leukocyte function,
thereby delaying tissue repair and increasing the risk of
infection.18 Obesity was also a significant predictor in
our study (OR = 1.9). Patel et al.10 observed that obese
patients had a higher incidence of wound infections,
pulmonary complications, and thromboembolism
compared with non-obese patients. Another study found
that obesity not only increased operative time and blood
loss but also prolonged hospital stay.19 The increased

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adipose tissue complicates surgical exposure, elevates
intra-abdominal pressure, and impairs respiratory
mechanics, thereby contributing to higher postoperative
morbidity. Although hypertension and ischemic heart
disease were not statistically significant predictors in
this study, their association with complications cannot
be disregarded. Lee et al.11 reported that hypertensive
patients experienced higher perioperative
cardiovascular events and delayed rehabilitation after
spine surgery. In our study, the lack of significance
might be attributed to effective perioperative
optimization and cardiology co-management of
patients. The association of COPD and smoking with
complications also did not reach significance in this
study, though trends were evident. Previous work by
Memtsoudis et al.20 demonstrated that patients with
pulmonary comorbidities had increased risks of
pneumonia and prolonged ventilation following spine
surgery. Smoking is also known to impair angiogenesis
and bone healing, leading to delayed fusion and
increased infection risk.21,22 The smaller sample size of
COPD patients in our cohort may explain the non-
significant results. The associations identified in this
study are biologically plausible. Diabetes delays wound
healing through impaired leukocyte function, reduced
angiogenesis, and microvascular disease.23 Obesity
contributes to chronic systemic inflammation, increases
intraoperative difficulty, and predisposes to venous
stasis and thromboembolic events.24 Cardiovascular
comorbidities compromise perfusion and oxygen
delivery to tissues, while pulmonary diseases limit
respiratory reserve, leading to postoperative hypoxia
and pneumonia.25 This finding highlights the
importance of evaluating not only individual
comorbidities but also their cumulative impact on
surgical outcomes. Our data indicate that
multimorbidity is a key predictor of poor recovery in
degenerative spondylosis patients. Future studies should
develop predictive models that integrate comorbidities,
surgical factors, and patient-specific variables for better
risk stratification. Additionally, research on
prehabilitation, glycemic control, and weight
management is crucial for reducing postoperative
complications. Context-specific guidelines are also
needed in Pakistan to address the rising burden of
degenerative spinal disorders

LIMITATIONS

This study’s cross-sectional design precludes
establishing causality. Data were collected from a
single tertiary hospital, limiting generalizability. Only
common comorbidities were assessed; factors such as
nutritional deficiencies and psychosocial stress were
excluded from the analysis. Some comorbidity data
relied on patient self-report, which may have introduced

recall bias.

CONCLUSIONS

Comorbidities, particularly diabetes, hypertension,
cardiovascular disease, and obesity, significantly
increase the risk of postoperative complications in
degenerative spondylosis patients. Patients with
multimorbidity are especially vulnerable.
Comprehensive preoperative assessment, strict
perioperative glycemic and cardiovascular control, and
weight optimization strategies should be prioritized.
Future multicenter, longitudinal studies are
recommended to validate these findings and guide
evidence-based practice in spine surgery.
CONFLICT OF INTEREST: None

FUNDING SOURCES: None
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AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.

Samir Khan Kabir - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Supervision;
Final Approval
Muhammad Zahid Khan - Concept & Design; Data
Acquisition; Data Analysis/Interpretation; Drafting
Manuscript; Critical Revision; Supervision; Final Approval
Abdul Sattar - Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Final Approval
Muhammad Arif Khan - Concept & Design; Data Acquisition;
Data Analysis/Interpretation; Drafting Manuscript; Final
Approval
Muhammad Waqar Khan - Concept & Design; Data
Acquisition; Data Analysis/Interpretation; Drafting
Manuscript; Final Approval

Impact of Comorbidities Postoperative Complications