Outcome of lumbar spinal fusion surgery in obese patients

Lingutla, Kiran; Pollock, R.; Benomran, E.; Purushothaman, Balaji; Kasis, Ata; Bhatia, Chandra; Krishna, Manoj; Friesem, Tai

doi:10.1302/0301-620x.97b10.35724

Cited by 54 publications

(47 citation statements)

References 31 publications

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“…1,3,14,29 These findings may be attributable to patient positioning, soft-tissue dissection, and inefficient or absent specialized equipment to enable expedient surgical intervention. With respect to hospital stay, it is plausible that the higher prevalence of comorbid conditions seen in the obese group-for example, obstructive airway disease, hypertension, diabetes mellitus, and coronary artery disease-may complicate recovery and consequentially extend the hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…12,25,26,31 Systematic reviews have identified obesity as an independent risk factor for increased blood loss, prolonged operating time, and more frequent complications with lumbar fusion surgery. 1,10,14 While most studies have revealed either a higher complication rate or increased resource utilization, inferior clinical outcomes in obese patients have not been consistently demonstrated. 14,28 Despite the current lack of evidence, a tendency to favor less extensive, nonfusion procedures in obese patients is plausible given the historically higher postoperative complication rates associated with these patients.…”

mentioning

confidence: 99%

“…1,10,14 While most studies have revealed either a higher complication rate or increased resource utilization, inferior clinical outcomes in obese patients have not been consistently demonstrated. 14,28 Despite the current lack of evidence, a tendency to favor less extensive, nonfusion procedures in obese patients is plausible given the historically higher postoperative complication rates associated with these patients. One possible reason for these higher rates could be that patients with higher BMIs are at risk for longer and more technically difficult procedures.…”

mentioning

confidence: 99%

“…Given the previous literature reporting satisfactory outcomes with lumbar fusion in obese patients, 5,14,15,22,25,29 we hypothesized that obese and nonobese patients would have comparable clinical benefit following lumbar spine surgery regardless of whether lumbar fusion was part of the procedure. Therefore, the purpose of the current study was to compare the outcomes of obese versus nonobese patients who had undergone surgical treatment for the diagnosis of lumbar spinal stenosis (LSS).…”

mentioning

confidence: 99%

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N2QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m2 (obese) or < 30 kg/m2 (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No significant differences were seen in 30-day readmission rates among the 4 cohorts. CONCLUSIONS Consistent with the prior literature, equivalent clinical outcomes were found among obese and non-obese patients treated for LSS. In addition, no difference in clinical outcomes as related to the extent of the surgical procedure was observed between obese and nonobese patients. Within the D+0 group, the nonobese patients had slightly better back pain scores at 2 years postoperatively. There may be a higher blood product requirement in obese patients following spine surgery, as well as an extended hospital stay, when fusion is performed. While obesity may influence the decision for or against surgery, the data suggest that obesity should not necessarily alter the appropriate procedure for well-selected surgical candidates.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery

Onyekwelu

Glassman

Asher

et al. 2017

SPI

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“…To more fully explore in impact of obesity on the entire spine, Teraguchi et al [24] investigated the prevalence and distribution of intervertebral disc degeneration over the entire spine and found the age and obesity were associated with the presence of disc degeneration in all areas of the spine, indicating that obesity places stress across multiple regions of back. BMI and obesity have also been identified as a risk factor for adjacent segment diseases and post-operative complications among patients undergoing lumbar fusion for degenerative spine diseases [30,31,32,33,34,35,36,37,38,39,40]. Weight control before and after the surgery was observed to reduce the incidence of adjacent segment disease and improve the fusion surgery outcome [41,42].…”

Section: Introductionmentioning

confidence: 99%

Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis

Sheng

Feng

Zhang

et al. 2017

IJERPH

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Background: The link between body weight status and spinal diseases has been suggested by a number of cross-sectional and cohort studies with a limited range of patient populations. No population-representative samples have been used to examine the link between obesity and spinal diseases. The present study is based on a nationally representative sample drawn from the Medical Expenditure Panel Survey. Methods: Using the cross-sectional sample of the 2014 Medical Expenditure Panel Study, we built four weighted logistic regression analyses of the associations between body weight status and the following four spinal diseases: low back pain, spondylosis, other cervical disorders and intervertebral disc disorder (IDD). Each respondent’s body weight status was used as the key independent variable with three categories: normal/underweight, overweight, and obese. We controlled for marital status, gender, age, smoking status, household income, health insurance coverage, educational attainment and the use of health services for other major categories of diseases. Results: A total sample of 23,048 respondents was used in our analysis. Overweight and obese respondents, as compared to normal/underweight respondents, were more likely to develop lower back problems (Overweight: logged odds = 0.218, p < 0.01; Obese: logged odds = 0.395, p < 0.001) and IDD (Overweight: logged odds = 0.441, p < 0.05; Obese: logged odds = 0.528, p < 0.001). The associations between bodyweight status and spondylitis were statistically insignificant (Overweight: logged odds = 0.281, p = 0.442; Obese: logged odds = 0.680, p = 0.104). The associations between body weight status and other cervical disorders (Overweight: logged odds = −0.116, p = 0.304; Obese: logged odds = −0.160, p = 0.865) were statistically insignificant. Conclusions: As the first study using a national sample to study bodyweight and spinal diseases, our paper supports the hypothesis that obesity adds to the burden of low back pain and IDD. Longitudinal and interventional studies are needed to understand the specific mechanisms behind these positive associations.

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