Obesity Is Associated With Inferior Results After Surgery for Lumbar Spinal Stenosis

Knutsson, Björn; Michaëlsson, Karl; Sandén, Bengt

doi:10.1097/brs.0b013e318270b243

Cited by 149 publications

(101 citation statements)

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“…In a large-registry study of 2633 lumbar stenosis patients, obese patients, in general, had less satisfaction following surgery. 13 However, in a study by McGuire and colleagues, there was no difference between obese and nonobese patients in symptom satisfaction at 12 months following surgery specifically for degenerative lumbar spondylolisthesis. 17 It is important to note that in our multivariate analysis, when adjusting for potential confounders, BMI was not a significant independent predictor of satisfaction.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have shown that high patient satisfaction may be correlated with efficient and high-quality surgical care 28 and superior surgical outcomes. 20 Authors investigating lumbar spine surgery have specifically linked various patient characteristics to satisfaction, including smoking, depression, disability-derived unemployment, 4 sex, 9 obesity, 13 preoperative diagnosis, 7 payer status, worse baseline pain and disability scores, 6 and psychological comorbidity.…”

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confidence: 99%

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Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Chan

Bisson

Bydon

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe American Association of Neurological Surgeons launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data, to measure the safety and quality of neurosurgical procedures, including spinal surgery. Differing results from recent randomized controlled trials have established a need to clarify the groups that would most benefit from surgery for degenerative lumbar spondylolisthesis. In the present study, the authors compared patients who were the most and the least satisfied following surgery for degenerative lumbar spondylolisthesis.METHODSThis was a retrospective analysis of a prospective, national longitudinal registry including patients who had undergone surgery for grade 1 degenerative lumbar spondylolisthesis. The most and least satisfied patients were identified based on an answer of “1” and “4,” respectively, on the North American Spine Society (NASS) Satisfaction Questionnaire 12 months postoperatively. Baseline demographics, clinical variables, surgical parameters, and outcomes were collected. Patient-reported outcome measures, including the Numeric Rating Scale (NRS) for back pain, NRS for leg pain, Oswestry Disability Index (ODI), and EQ-5D (the EuroQol health survey), were administered at baseline and 3 and 12 months after treatment.RESULTSFour hundred seventy-seven patients underwent surgery for grade 1 degenerative lumbar spondylolisthesis in the period from July 2014 through December 2015. Two hundred fifty-five patients (53.5%) were the most satisfied and 26 (5.5%) were the least satisfied. Compared with the most satisfied patients, the least satisfied ones more often had coronary artery disease (CAD; 26.9% vs 12.2%, p = 0.04) and had higher body mass indices (32.9 ± 6.5 vs 30.0 ± 6.0 kg/m2, p = 0.02). In the multivariate analysis, female sex (OR 2.9, p = 0.02) was associated with the most satisfaction. Notably, the American Society of Anesthesiologists (ASA) class, smoking, psychiatric comorbidity, and employment status were not significantly associated with satisfaction. Although there were no significant differences at baseline, the most satisfied patients had significantly lower NRS back and leg pain and ODI scores and a greater EQ-5D score at 3 and 12 months postoperatively (p < 0.001 for all).CONCLUSIONSThis study revealed that some patient factors differ between those who report the most and those who report the least satisfaction after surgery for degenerative lumbar spondylolisthesis. Patients reporting the least satisfaction tended to have CAD or were obese. Female sex was associated with the most satisfaction when adjusting for potential covariates. These findings highlight several key factors that could aid in setting expectations for outcomes following surgery for degenerative lumbar spondylolisthesis.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Chan

Bisson

Bydon

et al. 2018

Neurosurgical Focus

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“…In the present study, obese patients were more likely to require a decompression, which is consistent with previous studies that suggested obesity is a risk factor for spinal stenosis. 21,34,67 …”

Section: Discussion Patient Demographic Datamentioning

confidence: 99%

“…45,65,75 Similarly, there is no consensus on the impact of BMI on patient-reported outcomes. Several authors have reported inferior postoperative outcomes in obese patients undergoing elective degenerative lumbar, cervical, and deformity surgery, 2,34,76 whereas others did not find that obesity negatively impacts measures of health-related quality of life (HRQL). 15,26,53,70 In the spinal deformity literature, a publication by Smith et al identified high BMI as a risk factor for worse postoperative outcomes in both older and younger ASD patients undergoing surgical treatment.…”

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confidence: 99%

Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

Soroceanu

Burton

Diebo

et al. 2015

SPI

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OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement overtime, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

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“…These studies infer, that although specific disease characteristics pertaining to LSS may have a predictive value, psychosocial and demographic parameters are usually even more associated with the outcome of surgery (Sinikallio et al 2009;Atlas et al 2010;Cobo Soriano et al 2010;Pearson et al 2012). Additional factors of importance, as shown by data from the Swedish Spine Register, are smoking and obesity (Sandén et al 2011;Knutsson et al 2013). …”

Section: Outcome Of Surgery For Lumbar Spinal Stenosismentioning

confidence: 99%

Determinants of outcome in lumbar spinal stenosis surgery

Sigmundsson¹

2014

Acta Orthopaedica

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Cover illustration: "Spine Talk", acryl paint on stretched canvas. The painting was created in 2008 by the Canadian artist Barbara C. St Jean and is a painting of two people talking to each other over top of a spine of another. The painting was created to illustrate the problems associated with back pain and the discussions with medical professionals over the causes and treatment options. By permission from the artist.

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Obesity Is Associated With Inferior Results After Surgery for Lumbar Spinal Stenosis

Abstract: Obese patients achieved significant pain reduction, better walking ability, and improved quality of life after surgical treatment of LSS. Nevertheless, obesity was associated with a higher degree of dissatisfaction and poorer outcomes after surgery for LSS.

Cited by 149 publications

References 61 publications

Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

Determinants of outcome in lumbar spinal stenosis surgery

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