The Effect of Morbid Obesity on Complications, Readmission, and Patient-Reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: An Inverse Propensity Score Weighted Analysis.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Oct 2021
15 Oct 2021
Historique:
entrez:
24
9
2021
pubmed:
25
9
2021
medline:
29
9
2021
Statut:
ppublish
Résumé
Retrospective review of prospectively collected data at a single institution. To compare perioperative and clinical outcomes in morbidly obese patients who underwent minimally invasive transforaminal lumbar interbody fusion (MiTLIF). Obesity remains a serious public health concern. Obese patients who undergo lumbar fusion have historically thought to be at higher risk for complications and fare worse regarding quality-of-life outcomes. However, recent literature may demonstrate comparable risk and outcomes in obese patients. An increasing number of patients are categorized as morbidly obese (body mass index [BMI] ≥ 40 kg/m2). Perioperative and patient-reported outcomes (PROs) are lacking in this patient population. The authors retrospectively reviewed a prospectively collected database of all morbidly obese and non-obese patients that underwent MiTLIF between 2015 and 2018 for degenerative conditions who had minimum 1-year follow-up for outcome assessment. An inverse propensity/probability of treatment weighting was utilized to create a synthetic weighted sample in which covariates were independent of obesity designation to adjust for imbalance between groups. Generalized estimating equations (GEE) was used to estimate the association of morbid obesity and complications and 1-year PROs. A total of 292 patients were analyzed with 234 non-obese patients and 58 morbidly obese patients. Multivariate analysis failed to demonstrate any association between morbid obesity and achieving minimal clinically important difference (MCID) for Oswestry disability index (ODI), visual analog scale (VAS), or short form-12 (SF-12) physical component score. However, morbid obesity was associated with significant decrease in odds of achieving MCID for SF-12 mental component score (P = 0.001). Increased surgery duration was significantly associated with morbid obesity (P = 0.001). Morbid obesity exhibited no statistically significant association with postoperative complications, readmission, pseudarthrosis, or adjacent segment disease (ASD). Morbidly obese patients who undergo MiTLIF can achieve meaningful clinical improvement comparable to nonobese patients. Morbid obesity was associated with longer surgical times but was not associated with postoperative complications, readmission, or ASD.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective review of prospectively collected data at a single institution.
OBJECTIVE
OBJECTIVE
To compare perioperative and clinical outcomes in morbidly obese patients who underwent minimally invasive transforaminal lumbar interbody fusion (MiTLIF).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Obesity remains a serious public health concern. Obese patients who undergo lumbar fusion have historically thought to be at higher risk for complications and fare worse regarding quality-of-life outcomes. However, recent literature may demonstrate comparable risk and outcomes in obese patients. An increasing number of patients are categorized as morbidly obese (body mass index [BMI] ≥ 40 kg/m2). Perioperative and patient-reported outcomes (PROs) are lacking in this patient population.
METHODS
METHODS
The authors retrospectively reviewed a prospectively collected database of all morbidly obese and non-obese patients that underwent MiTLIF between 2015 and 2018 for degenerative conditions who had minimum 1-year follow-up for outcome assessment. An inverse propensity/probability of treatment weighting was utilized to create a synthetic weighted sample in which covariates were independent of obesity designation to adjust for imbalance between groups. Generalized estimating equations (GEE) was used to estimate the association of morbid obesity and complications and 1-year PROs.
RESULTS
RESULTS
A total of 292 patients were analyzed with 234 non-obese patients and 58 morbidly obese patients. Multivariate analysis failed to demonstrate any association between morbid obesity and achieving minimal clinically important difference (MCID) for Oswestry disability index (ODI), visual analog scale (VAS), or short form-12 (SF-12) physical component score. However, morbid obesity was associated with significant decrease in odds of achieving MCID for SF-12 mental component score (P = 0.001). Increased surgery duration was significantly associated with morbid obesity (P = 0.001). Morbid obesity exhibited no statistically significant association with postoperative complications, readmission, pseudarthrosis, or adjacent segment disease (ASD).
CONCLUSION
CONCLUSIONS
Morbidly obese patients who undergo MiTLIF can achieve meaningful clinical improvement comparable to nonobese patients. Morbid obesity was associated with longer surgical times but was not associated with postoperative complications, readmission, or ASD.Level of Evidence: 3.
Identifiants
pubmed: 34559749
doi: 10.1097/BRS.0000000000004059
pii: 00007632-202110150-00006
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1394-1401Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
Jimenez MP, Green MA, Subramanian SV, et al. A demographic, clinical, and behavioral typology of obesity in the United States: an analysis of National Health and Nutrition Examination Survey 2011-2012. Ann Epidemiol 2018; 28:175.e4–181.e4.
Djurasovic M, Bratcher KR, Glassman SD, et al. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976) 2008; 33:1789–1792.
Gaudelli C, Thomas K. Obesity and early reoperation rate after elective lumbar spine surgery: a population-based study. Evid Based Spine Care J 2012; 3:11–16.
Buerba RA, Fu MC, Gruskay JA, et al. Obese Class III patients at significantly greater risk of multiple complications after lumbar surgery: an analysis of 10,387 patients in the ACS NSQIP database. Spine J 2014; 14:2008–2018.
Kalanithi PA, Arrigo R, Boakye M. Morbid obesity increases cost and complication rates in spinal arthrodesis. Spine (Phila Pa 1976) 2012; 37:982–988.
Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 2007; 6:291–297.
Soroceanu A, Burton DC, Diebo BG, et al. Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery. J Neurosurg Spine 2015; 23:656–664.
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 (Phila Pa 1976) 2012; 37:1933–1946.
McGuire KJ, Khaleel MA, Rihn JA, et al. The effect of extreme obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial (SPORT). Spine (Phila Pa 1976) 2014; 39:1975–1980.
Knutsson B, Michaelsson K, Sanden B. Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. [Miscellaneous Article]. Spine (Phila Pa 1976) 2013; 38:435–441.
Rihn JA, Kurd M, Hilibrand AS, et al. The influence of obesity on the outcome of treatment of lumbar disc herniation: analysis of the spine patient outcomes research trial (SPORT). J Bone Joint SurgAm 2013; 95:1–8.
Abdallah DY, Jadaan MM, McCabe JP. Body mass index and risk of surgical site infection following spine surgery: a meta-analysis. Eur Spine J 2013; 22:2800–2809.
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 Relat Res 2014; 472:968–975.
Lingutla KK, Pollock R, Benomran E, et al. Outcome of lumbar spinal fusion surgery in obese patients: a systematic review and meta-analysis. Bone Joint J 2015; 97-B:1395–1404.
Park P, Wang MY, Nguyen S, et al. Comparison of complications and clinical and radiographic outcomes between nonobese and obese patients with adult spinal deformity undergoing minimally invasive surgery. World Neurosurg 2016; 87:55–60.
De la Garza-Ramos R, Bydon M, Abt NB, et al. The impact of obesity on short- and long-term outcomes after lumbar fusion. Spine (Phila Pa 1976) 2015; 40:56–61.
Terman SW, Yee TJ, Lau D, et al. Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients. J Neurosurg Spine 2014; 20:644–652.
Adogwa O, Carr K, Thompson P, et al. A Prospective, multi-institutional comparative effectiveness study of lumbar spine surgery in morbidly obese patients: does minimally invasive transforaminal lumbar interbody fusion result in superior outcomes? World Neurosurg 2015; 83:860–866.
Rosen DS, Ferguson SD, Ogden AT, et al. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery 2008; 63:956–960. discussion 960.
Wang J, Zhou Y, Feng Zhang Z, et al. Comparison of the clinical outcome in overweight or obese patients after minimally invasive versus open transforaminal lumbar interbody fusion. J Spinal Disord Tech 2014; 27:202–206.
Krüger MT, Naseri Y, Hohenhaus M, et al. Impact of morbid obesity (BMI > 40 kg/m2) on complication rate and outcome following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Clin Neurol Neurosurg 2019; 178:82–85.
Seicean A, Alan N, Seicean S, et al. Impact of increased body mass index on outcomes of elective spinal surgery. Spine (Phila Pa 1976) 2014; 39:1520–1530.
Lytle EJ, Slavnic D, Tong D, et al. Minimally effective dose of bone morphogenetic protein in minimally invasive lumbar interbody fusions: six hundred ninety patients in a dose-finding longitudinal cohort study. Spine (Phila Pa 1976) 2019; 44:989–995.
Carreon LY, Puno RM, Dimar JR, et al. Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 2003; 85-A:2089–2092.
Radcliff KE, Kepler CK, Jakoi A, et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J 2013; 13:1339–1349.
Okuda S, Yamashita T, Matsumoto T, et al. Adjacent segment disease after posterior lumbar interbody fusion: a case series of 1000 patients. Global Spine J 2018; 8:722–727.
Díaz-Arribas MJ, Fernández-Serrano M, Royuela A, et al. Minimal clinically important difference in quality of life for patients with low back pain. Spine (Phila Pa 1976) 2017; 42:1908–1916.
Copay AG, Glassman SD, Subach BR, et al. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and Pain Scales. Spine J 2008; 8:968–974.
Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46:399–424.
Rosenbaum PR. Model-based direct adjustment. J Am Stat Assoc 1987; 82:387–394.
Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 2015; 34:3661.
Cole SR, Hernán MA. Constructing inverse probability weights for marginal structural models. Am J Epidemiol 2008; 168:656–664.
Copay AG, Subach BR, Glassman SD, et al. Understanding the minimum clinically important difference: a review of concepts and methods. Spine J 2007; 7:541–546.
Bernstein JA, Mauger DT. The minimally clinically important difference (MCID): what difference does it make? J Allergy Clin Immunol Pract 2016; 4:689–690.
Claus CF, Lytle E, Carr DA, et al. Big data registries in spine surgery research: the lurking dangers. BMJ Evid Based Med. Epub ahead of print March 21, 2020. DOI: 10.1136/bmjebm-2019-111333.
de Vet HC, Terwee CB, Ostelo RW, et al. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 2006; 4:54.
McAnany SJ, Patterson DC, Overley S, et al. The effect of obesity on the improvement in health state outcomes following minimally invasive transforaminal interbody fusion. Global Spine J 2016; 6:744–748.
Lau D, Ziewacz J, Park P. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity. J Clin Neurosci 2013; 20:80–83.
Onyekwelu I, Glassman SD, Asher AL, et al. Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery. J Neurosurg Spine 2017; 26:158–162.
Ou C-Y, Lee T-C, Lee T-H, et al. Impact of body mass index on adjacent segment disease after lumbar fusion for degenerative spine diseases. Neurosurgery 2015; 76:396–402.
Wang H, Ma L, Yang D, et al. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore) 2017; 96:e6032.