Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes

Jannik Leyendecker Department of Neurological Surgery, University of Washington, Seattle, Washington;
Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany;

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Braeden Benedict Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri;

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Chayanne Gumbs University of Connecticut, Farmington, Connecticut;

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Peer Eysel Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany;

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Jan Bredow Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany;
Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Germany;

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Albert Telfeian Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island;

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Peter Derman Texas Back Institute, Plano, Texas;

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Osama Kashlan Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan; and

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Anubhav Amin Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany;

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Sanjay Konakondla Department of Neurosurgery, Geisinger Neuroscience Institute, Danville, Pennsylvania

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Christoph P. Hofstetter Department of Neurological Surgery, University of Washington, Seattle, Washington;

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John Ogunlade Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri;

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OBJECTIVE

An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients.

METHODS

Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18–30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure.

RESULTS

A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (−3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (−4.4 ± 3.2 vs −2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: −11.4 ± 11.4 vs −9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: −4.3 ± 3.9 vs −3.5 ± 3.8, p = 0.28).

CONCLUSIONS

The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.

ABBREVIATIONS

FESS = full endoscopic spine surgery; LE-ULBD = lumbar endoscopic unilateral laminotomy for bilateral decompression; MCID = minimal clinically important difference; MISS = minimally invasive spine surgery; ODI = Oswestry Disability Index; PROM = patient-reported outcome measure; VAS = visual analog scale.
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Images from Özer and Demirtaş (pp 351–358).
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