Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

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  • 1 Department of Neurosurgery, Duke University Medical Center; and
  • 2 Division of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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OBJECTIVE

Obese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.

METHODS

A search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.

RESULTS

A total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.

CONCLUSIONS

Higher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

ABBREVIATIONS AUC = area under the ROC curve; MCID = minimal clinically important difference; MD = mean difference; NASS = North American Spine Society; ODI = Oswestry Disability Index; QOD = Quality Outcomes Database; ROC = receiver operating characteristic; VAS-BP = visual analog scale for back pain; VAS-LP = VAS for leg pain.

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Contributor Notes

Correspondence Oren N. Gottfried: Duke University Medical Center, Durham, NC. oren.gottfried@duke.edu.

INCLUDE WHEN CITING Published online September 25, 2020; DOI: 10.3171/2020.6.SPINE20592.

Disclosures Dr. Shaffrey: consultant for Medtronic, NuVasive, and SI Bone; direct stock ownership in NuVasive; patent holder with Medtronic, NuVasive, and Zimmer Biomet; and royalties from Medtronic and NuVasive.

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