Lumbar Spine Fusion in Obese and Morbidly Obese Patients

Vaidya, Rahul; Carp, Julia; Bartol, Stephen; Ouellette, Nicole; Lee, Sandra; Sethi, Anil

doi:10.1097/brs.0b013e318198c5f2

Cited by 145 publications

(121 citation statements)

References 11 publications

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“…Similarly, Vaidya et al reported on surgical parameters and clinical outcomes after open lumbar fusion in obese patients. They found that although surgical blood loss and peri-operative complications were significantly higher in obese patients, post-operative ODI was not affected by obesity [12]. Contradictory findings were published by Gepstein et al, where obesity was found to be a significant independent risk factor for worse preand post-operative VAS scores as well as Barthel indices (assessment of ability to perform ADLs) in patients undergoing open lumbar spine surgery.…”

Section: Discussionsupporting

confidence: 53%

“…Additionally, obese patients that were managed operatively demonstrated significantly less improvement and lower final follow up values in the Sciatica Bothersomeness and Low Back Pain Bothersomeness Indices [42]. Though seemingly at odds with other clinical studies [12,20,[34][35][36], this as-treated analysis of the SPORT study has the benefit of a prospective design with large samples from multiple geographic locals and medical centers and long-term follow up which affords favorable generalizability of its results to true values expected in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have linked obesity to high rates of low back pain and lumbar degenerative disc disease [2][3][4]. When compared to non-obese patients, obese patients undergoing surgical lumbar decompression have been shown to have greater rates of perioperative and postoperative complications, yet have demonstrated equivalent outcomes regarding improvement in pain and functional disability [5][6][7][8][9][10][11][12]. Thus, the obese patient presents a unique challenge to the treating physician as the benefits of lumbar surgery are weighed against the high rate of potential complications.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

McAnany¹,

Overley²,

Andelman³

et al. 2015

Integr Obesity Diabetes

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

McAnany¹,

Overley²,

Andelman³

et al. 2015

Integr Obesity Diabetes

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show abstract

“…Obesity is a growing public health problem with evidence of a shift in population trends towards higher BMI. The number of patients with elevated BMI undergoing spine procedures, therefore, is rising [67]. Patients with higher BMI have been found to have lower serum and tissue concentrations of prophylactic antibiotics and, thus, inadequate protection against SSI [68].…”

Section: Odds Ratiomentioning

confidence: 99%

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

2013

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Purpose Inconsistent results have been reported in the literature on the association between obesity, expressed as increased body mass index (BMI), and risk for surgical site infection (SSI) following spine surgery. The objective of this study was to review and quantify the association between increased BMI and risk of spinal SSI in adults. Methods We performed a comprehensive search for relevant studies using PubMed, Embase, and references of published manuscripts. Study-specific risk measures were transformed into slope estimates and combined using the random effects meta-analysis model to establish the risk of SSI associated with every 5-unit increase in BMI. Results Thirty-four articles underwent full-text review. Variations were noted among these studies in relation to SSI diagnosis criteria and BMI cut-off levels used to define obesity. Data from 12 retrospective studies were included in the analyses. Results showed that BMI was significantly positively associated with the risk of spinal SSI. Unadjusted risk estimates demonstrated that a 5-unit increase in BMI was associated with 13 % increased risk of SSI [Crude odds ratio (OR): 1.13; 95 % CI: 1.07-1.19, p\ 0.0001]. Pooling of risk estimates adjusted for diabetes and other confounders resulted in a 21 % increase in risk of spinal SSI for every 5-unit increase in BMI (adjusted OR: 1.21; 95 % CI 1.13-1.29, p \ 0.0001). ConclusionHigher BMI is associated with the increased risk of SSI following spine surgery. Prospective studies are needed to confirm this association and to determine whether other measures of fat distribution are better predictors of risk of SSI.

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“…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%

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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Lumbar Spine Fusion in Obese and Morbidly Obese Patients

Cited by 145 publications

References 11 publications

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

The effect of obesity on patient-reported outcome measures after minimally invasive transforaminal lumbar interbody fusion

Body mass index and risk of surgical site infection following spine surgery: a meta-analysis

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

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