BMI Does Not Affect Complications or Patient Reported Outcomes After Lumbar Decompression Surgery.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
pubmed:
30
4
2020
medline:
26
10
2021
entrez:
30
4
2020
Statut:
ppublish
Résumé
This is a retrospective comparative review. The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery. Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes. Records from a single-center, academic hospital were used to identify patients undergoing 1 to 3-level lumbar decompression surgery. Patients under 18 years of age, those undergoing surgery for infection, trauma, tumor, or revision, and those with <1-year follow-up were excluded. Patients were split into groups based on preoperative BMI: class I: BMI <25.0 kg/m; class II: BMI 25.0-29.9 kg/m; class III: BMI 30.0-34.9 kg/m; and class IV: BMI >35.0 kg/m. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed. A total of 195 patients were included with 34 (17.4%) patients in group I, 80 (41.0%) in group II, 49 (25.1%) in group III, and 32 (16.5%) in group IV. Average age was 60.0 (58.0, 62.0) years and average follow-up was 13.0 (12.6, 13.4) months. All patients improved significantly within each group, except for class III and class IV patients, who did not demonstrate significant improvements in terms of Mental Component Score (MCS-12) scores (P=0.546 and 0.702, respectively). There were no significant differences between BMI groups for baseline or postoperative PROM values, recovery ratio, or the percent of patients reaching minimum clinically important difference. Multiple linear regression analysis revealed that BMI was not a significant predictor for change in outcomes for any measure. The 30-day readmission rate was 6.2% and overall revision rate at final follow-up was 5.1%, with no significant differences between groups. This study's results suggest that BMI may not significantly affect complications or patient outcomes at 1-year in those undergoing lumbar decompression surgery. Level III.
Sections du résumé
STUDY DESIGN
This is a retrospective comparative review.
OBJECTIVE
The objective of this study was to identify the influence of body mass index (BMI) on postsurgical complications and patient reported outcomes measures (PROMs) following lumbar decompression surgery.
SUMMARY OF BACKGROUND DATA
Current literature does not accurately identify the impact of BMI on postsurgical complications or outcomes.
MATERIALS AND METHODS
Records from a single-center, academic hospital were used to identify patients undergoing 1 to 3-level lumbar decompression surgery. Patients under 18 years of age, those undergoing surgery for infection, trauma, tumor, or revision, and those with <1-year follow-up were excluded. Patients were split into groups based on preoperative BMI: class I: BMI <25.0 kg/m; class II: BMI 25.0-29.9 kg/m; class III: BMI 30.0-34.9 kg/m; and class IV: BMI >35.0 kg/m. Absolute PROM scores, the recovery ratio and the percent of patients achieving minimum clinically important difference between groups were compared and a multiple linear regression analysis was performed.
RESULTS
A total of 195 patients were included with 34 (17.4%) patients in group I, 80 (41.0%) in group II, 49 (25.1%) in group III, and 32 (16.5%) in group IV. Average age was 60.0 (58.0, 62.0) years and average follow-up was 13.0 (12.6, 13.4) months. All patients improved significantly within each group, except for class III and class IV patients, who did not demonstrate significant improvements in terms of Mental Component Score (MCS-12) scores (P=0.546 and 0.702, respectively). There were no significant differences between BMI groups for baseline or postoperative PROM values, recovery ratio, or the percent of patients reaching minimum clinically important difference. Multiple linear regression analysis revealed that BMI was not a significant predictor for change in outcomes for any measure. The 30-day readmission rate was 6.2% and overall revision rate at final follow-up was 5.1%, with no significant differences between groups.
CONCLUSION
This study's results suggest that BMI may not significantly affect complications or patient outcomes at 1-year in those undergoing lumbar decompression surgery.
LEVEL OF EVIDENCE
Level III.
Identifiants
pubmed: 32349060
doi: 10.1097/BSD.0000000000001001
pii: 01933606-202012000-00028
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
E579-E585Références
Best MJ, Buller LT, Eismont FJ. National trends in ambulatory surgery for intervertebral disc disorders and spinal stenosis: a 12-year analysis of the national surveys of ambulatory surgery. Spine. 2015;40:1703–1711.
Gandhi SD, Radcliff KE. Obesity in lumbar spine surgery. Curr Orthop Pract. 2016;27:135–139.
Epstein NE. More risks and complications for elective spine surgery in morbidly obese patients. Surg Neurol Int. 2017;8:66.
Goyal A, Elminawy M, Kerezoudis P, et al. Impact of obesity on outcomes following lumbar spine surgery: a systematic review and meta-analysis. Clin Neurol Neurosurg. 2019;177:27–36.
Yao R, Zhou H, Choma TJ, et al. Surgical site infection in spine surgery: who is at risk? Glob Spine J. 2018;8(suppl):5S–30S.
Nasser R, Kosty JA, Shah S, et al. Risk factors and prevention of surgical site infections following spinal procedures. Glob Spine J. 2018;8(suppl):44S–48S.
Spina NT, Aleem IS, Nassr A, et al. Surgical site infections in spine surgery: preoperative prevention strategies to minimize risk. Glob Spine J. 2018;8(suppl):31S–36S.
Rihn JA, Radcliff K, Hilibrand AS, et al. Does obesity affect outcomes of treatment for lumbar stenosis and degenerative spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine. 2012;37:1933–1946.
McGuire KJ, Khaleel MA, Rihn JA, et al. The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine. 2014;39:1975–1980.
Gelalis ID, Papanastasiou EI, Pakos EE, et al. Clinical outcomes after lumbar spine microdiscectomy: a 5-year follow-up prospective study in 100 patients. Eur J Orthop Surg Traumatol. 2019;29:321–327.
Burgstaller JM, Held U, Brunner F, et al. The Impact of Obesity on the Outcome of Decompression Surgery in Degenerative Lumbar Spinal Canal Stenosis: analysis of the Lumbar Spinal Outcome Study (LSOS): A Swiss Prospective Multicenter Cohort Study. Spine. 2016;41:82–89.
Centers for Disease Control and Prevention (CDC). Surgical Site Infection (SSI) Event; 2019. Available at: www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed May 9, 2019.
Radcliff K, Davis RJ, Hisey MS, et al. Long-term evaluation of cervical disc arthroplasty with the Mobi-C© cervical disc: a randomized, prospective, multicenter clinical trial with seven-year follow-up. Int J Spine Surg. 2017;11:31.
Parker SL, Mendenhall SK, Shau D, et al. Determination of minimum clinically important difference in pain, disability, and quality of life after extension of fusion for adjacent-segment disease. J Neurosurg Spine. 2012;16:61–67.
Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J. 2011;20:475–481.
Knutsson B, Michaëlsson K, Sandén B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine. 2013;38:435–441.
Bono OJ, Poorman GW, Foster N, et al. Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. Spine J. 2018;18:1204–1210.
Jiang J, Teng Y, Fan Z, et al. Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop. 2014;472:968–975.
Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine. 2014;39:1520–1530.
Pull ter Gunne AF, Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery. Spine. 2009;34:1422–1428.
Friedman ND, Sexton DJ, Connelly SM, et al. Risk factors for surgical site infection complicating laminectomy. Infect Control Hosp Epidemiol. 2007;28:1060–1065.
Gaynes RP, Culver DH, Horan TC, et al. Surgical site infection (SSI) rates in the United States, 1992-1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33(suppl 2):S69–S77.
Collins I, Wilson-MacDonald J, Chami G, et al. The diagnosis and management of infection following instrumented spinal fusion. Eur Spine J. 2008;17:445–450.
Kanayama M, Hashimoto T, Shigenobu K, et al. Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline-based antimicrobial prophylaxis in lumbar spine surgery. J Neurosurg Spine. 2007;6:327–329.
Picada R, Winter RB, Lonstein JE, et al. Postoperative deep wound infection in adults after posterior lumbosacral spine fusion with instrumentation: incidence and management. J Spinal Disord. 2000;13:42–45.
Mirovsky Y, Floman Y, Smorgick Y, et al. Management of deep wound infection after posterior lumbar interbody fusion with cages. J Spinal Disord Tech. 2007;20:127–131.
Chahoud J, Kanafani Z, Kanj SS. Surgical site infections following spine surgery: eliminating the controversies in the diagnosis. Front Med. 2014;1:7.