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Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions?

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Abstract

Purpose

To investigate whether obesity is associated with worse patient-reported outcomes following surgery for degenerative lumbar conditions.

Methods

We evaluated consecutive patients undergoing elective lumbar laminectomy or laminectomy with fusion for degenerative lumbar conditions. The Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D), Short-Form 12 (SF-12), and NASS patient satisfaction were utilized. Chi-square tests and student t test assessed the association of obesity with PROs. Multivariate regression controlled for age, sex, smoking status, anxiety, depression, revision, preoperative narcotic use, payer status, and diabetes.

Results

A total of 602 patients were included. All PROs improved significantly in both groups. BMI ≥35 was associated with increased ODI at baseline (50.6 vs. 47.2 %, p = 0.012) and 12 months (30.5 vs. 25.7 %, p = 0.005). There was no difference in ODI change scores (21.2 vs. 19.4 %, p = 0.32). With multivariate analysis, BMI ≥35 was not predictive of worse ODI at 12 months (correlation coefficient 1.23, 95 % CI −0.225 to 2.676.) There was no significant difference between groups in percentage of patients achieving the minimum clinically important difference for ODI (59.6 vs. 64 %, p = 0.46) or patient satisfaction (80.5 vs. 78.9 %, p = 0.63).

Conclusions

Body mass index ≥35 is associated with worse baseline and 12-month PROs, however, there was no difference in change scores across BMI groups. Controlling for important co-variables, BMI greater than 35 was not an independent predictor of worse PROs at 12 months.

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References

  1. Caterson ID, Gill TP (2002) Obesity: epidemiology and possible prevention. Best Pract Res Clin Endocrinol Metab 16(4):595–610

    Article  PubMed  Google Scholar 

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM (2014) Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA 311(8):806–814. doi:10.1001/jama.2014.732

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Anandacoomarasamy A, Caterson I, Sambrook P, Fransen M, March L (2008) The impact of obesity on the musculoskeletal system. Int J Obes (2005) 32(2):211–222. doi:10.1038/sj.ijo.0803715

    Article  CAS  Google Scholar 

  4. Fanuele JC, Abdu WA, Hanscom B, Weinstein JN (2002) Association between obesity and functional status in patients with spine disease. Spine (Phila Pa 1976) 27(3):306–312

    Article  Google Scholar 

  5. Hangai M, Kaneoka K, Kuno S, Hinotsu S, Sakane M, Mamizuka N, Sakai S, Ochiai N (2008) Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J 8(5):732–740. doi:10.1016/j.spinee.2007.07.392

    Article  PubMed  Google Scholar 

  6. Knutsson B, Michaelsson K, Sanden B (2013) Obesity is associated with inferior results after surgery for lumbar spinal stenosis: a study of 2633 patients from the Swedish spine register. Spine (Phila Pa 1976) 38(5):435–441. doi:10.1097/BRS.0b013e318270b243

    Article  Google Scholar 

  7. Rihn JA, Kurd M, Hilibrand AS, Lurie J, Zhao W, Albert T, Weinstein J (2013) 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 Surg Am 95(1):1–8. doi:10.2106/jbjs.k.01558

    Article  PubMed  PubMed Central  Google Scholar 

  8. Seicean A, Alan N, Seicean S, Worwag M, Neuhauser D, Benzel EC, Weil RJ (2014) Impact of increased body mass index on outcomes of elective spinal surgery. Spine (Phila Pa 1976) 39(18):1520–1530. doi:10.1097/brs.0000000000000435

    Article  Google Scholar 

  9. Hanigan WC, Elwood PW, Henderson JP, Lister JR (1987) Surgical results in obese patients with sciatica. Neurosurgery 20(6):896–899

    Article  CAS  PubMed  Google Scholar 

  10. Vaidya R, Carp J, Bartol S, Ouellette N, Lee S, Sethi A (2009) Lumbar spine fusion in obese and morbidly obese patients. Spine (Phila Pa 1976) 34(5):495–500. doi:10.1097/BRS.0b013e318198c5f2

    Article  Google Scholar 

  11. Peng CW, Bendo JA, Goldstein JA, Nalbandian MM (2009) Perioperative outcomes of anterior lumbar surgery in obese versus non-obese patients. Spine J 9(9):715–720. doi:10.1016/j.spinee.2009.04.023

    Article  PubMed  Google Scholar 

  12. Koerner JD, Glaser J, Radcliff K (2014) Which variables are associated with patient-reported outcomes after discectomy?. Clin Orthop Relat Res, Rev SPORT Disc Herniation Studies. doi:10.1007/s11999-014-3671-1

    Google Scholar 

  13. Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY (2008) The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976) 33(16):1789–1792. doi:10.1097/BRS.0b013e31817b8f6f

    Article  Google Scholar 

  14. Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG (2008) Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery 63(5):956–960. doi:10.1227/01.neu.0000313626.23194.3f (discussion 960)

    Article  PubMed  Google Scholar 

  15. Buerba RA, Fu MC, Gruskay JA, Long WD 3rd, Grauer JN (2014) 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 14(9):2008–2018. doi:10.1016/j.spinee.2013.11.047

    Article  PubMed  Google Scholar 

  16. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Hanscom B, Skinner JS, Abdu WA, Hilibrand AS, Boden SD, Deyo RA (2006) Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA 296(20):2441–2450. doi:10.1001/jama.296.20.2441

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Rihn JA, Radcliff K, Hilibrand AS, Anderson DT, Zhao W, Lurie J, Vaccaro AR, Freedman MK, Albert TJ, Weinstein JN (2012) 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) 37(23):1933–1946. doi:10.1097/BRS.0b013e31825e21b2

    Article  Google Scholar 

  18. McGuire KJ, Khaleel MA, Rihn JA, Lurie JD, Zhao W, Weinstein JN (2014) The effect of high obesity on outcomes of treatment for lumbar spinal conditions: subgroup analysis of the spine patient outcomes research trial. Spine (Phila Pa 1976) 39(23):1975–1980. doi:10.1097/brs.0000000000000577

    Article  Google Scholar 

  19. Fairbank JC, Pynsent PB (2000) The Oswestry Disability Index. Spine (Phila Pa 1976) 25(22):2940–2952 (discussion 2952)

    Article  CAS  Google Scholar 

  20. Davidson M, Keating JL (2002) A comparison of five low back disability questionnaires: reliability and responsiveness. Phys Ther 82(1):8–24

    PubMed  Google Scholar 

  21. Parker SL, Adogwa O, Paul AR, Anderson WN, Aaronson O, Cheng JS, McGirt MJ (2011) Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine 14(5):598–604. doi:10.3171/2010.12.spine10472

    PubMed  Google Scholar 

  22. Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY (2008) Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 90(9):1839–1847. doi:10.2106/jbjs.g.01095

    Article  PubMed  Google Scholar 

  23. Ware J Jr, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34(3):220–233

    Article  PubMed  Google Scholar 

  24. Luo X, George ML, Kakouras I, Edwards CL, Pietrobon R, Richardson W, Hey L (2003) Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine (Phila Pa 1976) 28(15):1739–1745. doi:10.1097/01.brs.0000083169.58671.96

    Google Scholar 

  25. Jenkinson C, Layte R, Jenkinson D, Lawrence K, Petersen S, Paice C, Stradling J (1997) A shorter form health survey: can the SF-12 replicate results from the SF-36 in longitudinal studies? J Public Health Med 19(2):179–186

    Article  CAS  PubMed  Google Scholar 

  26. McCormick JD, Werner BC, Shimer AL (2013) Patient-reported outcome measures in spine surgery. J Am Acad Orthop Surg 21(2):99–107. doi:10.5435/jaaos-21-02-99

    Article  PubMed  Google Scholar 

  27. Guilfoyle MR, Seeley H, Laing RJ (2009) The short form 36 health survey in spine disease—validation against condition-specific measures. Br J Neurosurg 23(4):401–405. doi:10.1080/02688690902730731

    Article  PubMed  Google Scholar 

  28. Solberg TK, Olsen JA, Ingebrigtsen T, Hofoss D, Nygaard OP (2005) Health-related quality of life assessment by the EuroQol-5D can provide cost-utility data in the field of low-back surgery. Eur Spine J 14(10):1000–1007. doi:10.1007/s00586-005-0898-2

    Article  PubMed  Google Scholar 

  29. Jansson KA, Nemeth G, Granath F, Jonsson B, Blomqvist P (2009) Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br 91(2):210–216. doi:10.1302/0301-620x.91b2.21119

    Article  PubMed  Google Scholar 

  30. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23(18):2003–2013 (Phila Pa 1976)

    Article  CAS  PubMed  Google Scholar 

  31. WHO | Obesity and overweight (2015) World Health Organization. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 18 Dec 2015

  32. Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY (2008) Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 90(9):1839–1847. doi:10.2106/jbjs.g.01095 (United States)

    Article  PubMed  Google Scholar 

  33. Sinikallio S, Aalto T, Airaksinen O, Lehto SM, Kroger H, Viinamaki H (2011) Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study. Spine 36(8):677–682. doi:10.1097/BRS.0b013e3181dcaf4a (Phila Pa 1976)

    Article  PubMed  Google Scholar 

  34. Schade V, Semmer N, Main CJ, Hora J, Boos N (1999) The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain 80(1–2):239–249

    Article  CAS  PubMed  Google Scholar 

  35. Browne JA, Cook C, Pietrobon R, Bethel MA, Richardson WJ (2007) Diabetes and early postoperative outcomes following lumbar fusion. Spine (Phila Pa 1976) 32(20):2214–2219. doi:10.1097/BRS.0b013e31814b1bc0 (United States)

    Article  Google Scholar 

  36. Lee D, Armaghani S, Archer KR, Bible J, Shau D, Kay H, Zhang C, McGirt MJ, Devin C (2014) Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am 96(11):e89. doi:10.2106/jbjs.m.00865

    Article  PubMed  Google Scholar 

  37. Andersen T, Christensen FB, Laursen M, Hoy K, Hansen ES, Bunger C (2001) Smoking as a predictor of negative outcome in lumbar spinal fusion. Spine (Phila Pa 1976) 26(23):2623–2628

    Article  CAS  Google Scholar 

  38. Sinikallio S, Aalto T, Airaksinen O, Herno A, Kroger H, Savolainen S, Turunen V, Viinamaki H (2007) Depression is associated with poorer outcome of lumbar spinal stenosis surgery. Eur Spine J 16(7):905–912. doi:10.1007/s00586-007-0349-3

    Article  PubMed  PubMed Central  Google Scholar 

  39. Malmivaara A, Slatis P, Heliovaara M, Sainio P, Kinnunen H, Kankare J, Dalin-Hirvonen N, Seitsalo S, Herno A, Kortekangas P, Niinimaki T, Ronty H, Tallroth K, Turunen V, Knekt P, Harkanen T, Hurri H (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976) 32(1):1–8. doi:10.1097/01.brs.0000251014.81875.6d

    Article  Google Scholar 

  40. Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356(22):2257–2270. doi:10.1056/NEJMoa070302

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358(8):794–810. doi:10.1056/NEJMoa0707136

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Medical Center East–South Tower, Suite 4200, Nashville, TN, 37232, USA

    J. Alex Sielatycki, Silky Chotai & Clinton J. Devin

  2. Vanderbilt University School of Medicine, Nashville, TN, USA

    David Stonko, Joseph Wick & Harrison Kay

  3. Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA

    Matthew J. McGirt

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  1. J. Alex Sielatycki
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  2. Silky Chotai
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Correspondence to Clinton J. Devin.

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Sielatycki, J.A., Chotai, S., Stonko, D. et al. Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions?. Eur Spine J 25, 1627–1633 (2016). https://doi.org/10.1007/s00586-016-4460-1

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  • DOI: https://doi.org/10.1007/s00586-016-4460-1

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