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Impact of body mass index on PROMIS outcomes following lumbar decompression

  • Original Article - Spine - Other
  • Published:
Acta Neurochirurgica Aims and scope

Abstract

Background

No studies have examined the impact of body mass index (BMI) on newer Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes in patients undergoing lumbar decompression (LD).

Methods

Patients undergoing LD with preoperative PROMIS measures were stratified into four cohorts: normal (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2), obese I (30 ≤ BMI < 35 kg/m2), and obese II–III (BMI ≥ 35 kg/m2). Demographics, perioperative characteristics, and patient-reported outcomes (PROs) were obtained. PROs of PROMIS Physical Function (PROMIS-PF), PROMIS Anxiety (PROMIS-A), PROMIS Pain Interference (PROMIS-PI), PROMIS Sleep Disturbance (PROMIS-SD), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back Pain (VAS-BP), VAS Leg Pain (VAS-LP), and Oswestry Disability Index (ODI) were collected at preoperative and up to 2-year postoperative time points. Minimum clinically important difference (MCID) achievement was determined through comparison of previously established values. Comparison between cohorts were determined through inferential statistics.

Results

A total of 473 patients were identified, with stratification of 125 patients in the normal cohort, 161 in the overweight cohort, 101 in the obese I cohort, and 87 in the obese II–III cohort. Mean postoperative follow-up time was 13.51 ± 8.72 months. Higher BMI patients had higher operative times, longer postoperative length of stay, and greater narcotic consumption (p ≤ 0.001, all). Patients with higher BMI (obese I, obese II–III) reported inferior preoperative PROMIS-PF, VAS-BP, and ODI scores (p ≤ 0.003, all). Postoperatively, obese I–III cohorts demonstrated inferior PROMIS-PF, PHQ-9, VAS-BP, and ODI scores at final follow-up (p ≤ 0.016, all). However, patients demonstrated similar postoperative changes and MCID achievement regardless of preoperative BMI.

Conclusion

Patients undergoing lumbar decompression demonstrated similar postoperative improvement in physical function, anxiety, pain interference, sleep disturbance, mental health, pain, and disability outcomes independent of preoperative BMI. However, obese patients reported worse physical function, mental health, back pain, and disability outcomes at final postoperative follow-up. Patients with greater BMI undergoing lumbar decompression demonstrate inferior postoperative clinical outcomes.

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Data Availability

The data that support the findings of this study were generated at Rush University Medical Center and are available upon reasonable request from the corresponding author KS.

Abbreviations

ANOVA:

Analysis of variance

ASA:

American Society of Anesthesiologists

BMI :

Body mass index

CCI:

Charlson Comorbidity Index

EBL:

Estimated blood loss

LD:

Lumbar decompression

LOS:

Length of stay

MCID:

Minimum clinically important difference

ODI:

Oswestry Disability Index

ORA :

Office of Regulatory Affairs

PHQ-9:

Patient Health Questionnaire-9

POD:

Postoperative day

PROMIS:

Patient-Reported Outcomes Measurement Information System

PROMIS-A:

Patient-Reported Outcomes Measurement Information System Anxiety

PROMIS-PF:

Patient-Reported Outcomes Measurement Information System Physical Function

PROMIS-PI:

Patient-Reported Outcomes Measurement Information System Pain Interference

PROMIS-SD:

Patient-Reported Outcomes Measurement Information System Sleep Disturbance

PROs :

Patient-reported outcome

SF-12:

12-Item Short Form

SF-36 PCS :

36-Item Short Form Physical Component Score

VAS:

Visual Analog Scale

VAS-BP:

Visual Analog Scale Back Pain

VAS-LP:

Visual Analog Scale Leg Pain

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite #300, IL, 60612, Chicago, USA

    James W. Nie, Timothy J. Hartman, Eileen Zheng, Omolabake O. Oyetayo, Keith R. MacGregor, Vincent P. Federico, Dustin H. Massel, Arash J. Sayari & Kern Singh

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  1. James W. Nie
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  2. Timothy J. Hartman
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Contributions

James W. Nie, BS: Conceptualization, methodology, visualization, formal analysis, software, investigation, writing — original draft, writing — review and editing.

Timothy J. Hartman, MD: Conceptualization, methodology, visualization, formal analysis, software, investigation, writing — original draft, writing — review and editing.

Eileen Zheng, BS: Project administration, data curation, investigation, writing — review and editing.

Omolabake O. Oyetayo, BS: Project administration, data curation, investigation, writing — review and editing.

Keith R. MacGregor, BS: Project administration, data curation, investigation, writing — review and editing.

Vincent P. Federico, MD: Conceptualization, methodology, supervision, resources, investigation, writing — review and editing.

Dustin H. Massel, MD: Conceptualization, methodology, supervision, resources, investigation, writing — review and editing.

Arash J. Sayari, MD: Conceptualization, methodology, supervision, resources, investigation, writing — review and editing.

Corresponding author

Correspondence to Kern Singh.

Ethics declarations

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Rush University Medical Center (ORA #14051301).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Financial interests

Kern Singh, MD, receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. Kern Singh, MD, owns stock in Avaz Surgical LLC and Vital 5 LLC. Kern Singh, MD, holds a consulting position with Zimmer Biomet and K2M. Kern Singh, MD, holds board membership with Vital 5 LLC. Kern Singh, MD, is on the editorial board of Contemporary Spine Surgery. Kern Singh, MD, received a research grant from the Cervical Spine Research Society.

Non-financial interests

Kern Singh, MD, holds board membership with TDi LLC and Minimally Invasive Spine Study Group and receives no compensation as board member. Kern Singh, MD, is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as member of the editorial board. Kern Singh, MD, is on the board of directors of Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as member of the board of directors.

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Nie, J.W., Hartman, T.J., Zheng, E. et al. Impact of body mass index on PROMIS outcomes following lumbar decompression. Acta Neurochir 165, 1427–1434 (2023). https://doi.org/10.1007/s00701-023-05534-5

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  • DOI: https://doi.org/10.1007/s00701-023-05534-5

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