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Neurosurgery. 2018 Dec 12. doi: 10.1093/neuros/nyy589. [Epub ahead of print]

Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database.

Author information

1
Department of Neurological Surgery, University of California, San Francisco, California.
2
Department of Neurological Surgery, University of Utah, Salt Lake City, Utah.
3
Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
4
Norton Leatherman Spine Center, Louisville, Kentucky.
5
Department of Neurological Surgery, University of Tennessee; Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee.
6
Department of Neurological Surgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana.
7
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia.
8
Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina.
9
Atlantic Neurosurgical Specialists, Morristown, New Jersey.
10
Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan.
11
Department of Neurological Surgery, University of Miami, Miami, Florida.
12
Department of Neurological Surgery, Weill Cornell Medical Center, New York, New York.
13
Geisinger Health System, Danville, Pennsylvania.
14
Geisinger Health System Neurosciences Institute, Atlanta Brain and Spine Care, Atlanta, Georgia.

Abstract

BACKGROUND:

Given recent differing findings following 2 randomized clinical trials on degenerative lumbar spondylolisthesis (DLS) surgery, there is a need to better define how subsets of patients fare following surgery.

OBJECTIVE:

To investigate the impact of obesity on patient-reported outcomes (PROs) following DLS surgery.

METHODS:

A total of 12 high-enrolling sites were queried, and we found 797 patients undergoing surgery for grade 1 DLS. For univariate comparisons, patients were stratified by BMI ≥ 30 kg/m2 (obese) and < 30 kg/m2 (nonobese). Baseline, 3-mo, and 12-mo follow-up parameters were collected. PROs included the North American Spine Society satisfaction questionnaire, numeric rating scale (NRS) back pain, NRS leg pain, Oswestry Disability Index (ODI), and EuroQoL-5D (EQ-5D) Questionnaire.

RESULTS:

We identified 382 obese (47.9%) and 415 nonobese patients (52.1%). At baseline, obese patients had worse NRS back pain, NRS leg pain, ODI, and EQ-5D scores (P < .001, P = .01, P < .001, and P = .02, respectively). Both cohorts improved significantly for back and leg pain, ODI, and EQ-5D at 12 mo (P < .001). At 12 mo, similar proportions of obese and nonobese patients responded that surgery met their expectations (62.6% vs 67.4%, P = .24). In multivariate analyses, BMI was independently associated with worse NRS leg pain and EQ-5D at 12 mo (P = .01 and P = .02, respectively) despite adjusting for baseline differences.

CONCLUSION:

Obesity is associated with inferior leg pain and quality of life-but similar back pain, disability, and satisfaction-12 mo postoperatively. However, obese patients achieve significant improvements in all PRO metrics at 12 mo.

PMID:
30541141
DOI:
10.1093/neuros/nyy589

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