Aim:Anterior cervical discectomy and fusion (ACDF) is a common spine procedure for cervical spinal cord decompression and treatment. In recent years, the incidence of obesity and public health awareness of the deleterious effects of obesity on surgical outcomes has increased. This study investigates the impact of obesity on ACDF postoperative morbidity and mortality.Material and Methods:The American College of Surgeons’ National Surgical Quality Improvement Project (NSQIP) files from 2006 to 2019 were queried for all patients who underwent an ACDF. Fisher exact tests were used in analyzing univariate differences in preoperative comorbidities and postoperative morbidity and mortality between patients with and without obesity (BMI ≥ 30 kg/m2). Results with a p value < 0.05 were considered statistically significant. Multivariable logistic regression models were used in determining the independent impact of obesity on ACDF postoperative morbidity and mortality. A p value < 0.017 was required for multivariate statistical significance.Results:There were 96,882 patients who underwent an ACDF from 2006 to 2019 found. 53.77% had non-obese BMI. Patients had statistically significant differences in most perioperative comorbidities and postoperative outcomes on univariate analysis. On multivariate analysis, patients with obesity has decreased adjusted odds of wound infections (aOR = 0.7208, CI 0.574–0.9075, p = 0.0053), pulmonary events (aOR = 0.7939, CI 0.6903–0.9129, p = 0.0012), sepsis (aOR = 0.5670, CI 0.4359–0.7374, p = 2.32E-05), transfusion requirements (aOR = 0.5396, CI 0.4498–0.6473, p = 3.04E-11), return to operating room (aOR = 0.7537, CI 0.6727–0.8447, p = 1.17E-06), and length of stay > 10 days (aOR = 0.7061, CI 0.6438–0.7744, p = 1.49E-13).Conclusion:Obesity is a protective factor toward ACDF postoperative complications. Obesity as a marker of patient selection criteria for ACDF procedures should not be used by spine surgeons.