Details

Autor(en) / Beteiligte

• Owens, R. Kirk
• Djurasovic, Mladen
• Onyekwelu, Ikemefuna
• Bratcher, Kelly R.
• McGraw, Katlyn E.
• Carreon, Leah Y.

Titel

Outcomes and revision rates in normal, overweight, and obese patients 5 years after lumbar fusion

Ist Teil von

• The spine journal, 2016-10, Vol.16 (10), p.1178-1183

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

Elsevier ScienceDirect Journals

Beschreibungen/Notizen

• Obesity is a growing problem in health care. Studies have demonstrated similar functional outcomes but higher complication rates after spine surgery in obese patients. This study aimed to compare patient-reported outcomes and revision rates 5 years after instrumented posterior lumbar fusion between normal, overweight, and obese patients. Propensity matched case control. Patients who had posterior instrumented lumbar spinal fusion from 2001 to 2008 from a single spine specialty center with complete preoperative and 5-year postoperative outcome measures were identified. Oswestry Disability Index (ODI), Back Pain (0–10) and Leg Pain (0–10) Numeric Rating Scales, and Short Form-36 Physical Composite Summary Scores (SF-36 PCS). Three comparison groups, one with body mass index (BMI) ≥20–25 kg/m2 (normal), another with ≥25–<30 kg/m2 (overweight), and another with ≥30–40 kg/m2 (obese) were created using propensity matching techniques based on demographics, baseline clinical outcome measures, and surgical characteristics. Five-year postoperative outcome measures and revision rates in the three groups were compared. One-way analysis of variance was used to compare continuous variables, and Fisher exact test was used to compare categorical variables between the groups. Significance was set at p<.01. There were 82 cases matched in each cohort. Estimated blood loss (440 cc vs. 702 cc vs. 798 cc, p=.000) and operative time (234 minutes vs. 263 minutes vs. 275 minutes, p=.003) were significantly greater in the overweight and obese patients. Improvements in ODI (14.2 vs. 9.6 vs. 10.4, p=.226), SF-36 PCS (5.9 vs. 2.9 vs. 3.5, p=.361), back pain (3.0 vs. 2.0 vs. 2.1, p=.028), and leg pain (3.0 vs. 2.3 vs. 2.3, p=.311) scores were similar among the groups. Revision rates (14 vs. 15 vs. 13, p=.917), and time between index and revision surgery (p=.990) were similar among the three groups as well. When considering a subset of patient-reported outcomes and revision surgery after 5 years, patients with an elevated BMI >25 at baseline did not appear to have worse outcomes than those with a normal BMI of 20–25 when undergoing posterior lumbar fusion surgery. Obesity should not be considered a contraindication to surgery in patients with appropriate surgical indications.